Individual
DR. DIANE B EBAUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1005 W GREEN ST, SUITE 304, HASTINGS, MI 49058-1712
(269) 948-8057
(269) 948-8964
Mailing address
1005 W GREEN ST, SUITE 304, HASTINGS, MI 49058-1712
(269) 948-8057
(269) 948-8964
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DE046093
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1535189
—
MI
Enumeration date
03/27/2006
Last updated
02/19/2016
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