Individual
DR. DAMIAN D DIETER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1608 PORTAGE AVE, SOUTH BEND, IN 46616-1740
(574) 233-2966
(574) 233-2995
Mailing address
1608 PORTAGE AVE, SOUTH BEND, IN 46616-1740
(574) 233-2966
(574) 233-2995
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
07000803
IN
213ES0103X
Foot & Ankle Surgery Podiatrist
07000803
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07000803
INDIANA MEDICAL LICENSE
IN
05
—
200040300A
—
IN
01
—
351939564
PORTAGE FOOT CLINIC
IN
01
—
480019850
RAILROAD MEDICARE NUMBER
IN
01
—
738460TTTT
ST JOSEPH FAMILY MEDICINE CENTER
IN
Enumeration date
06/12/2006
Last updated
02/19/2026
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