Individual
DOUGLAS R DIEMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3200 W CENTRE AVE, SUITE 203, PORTAGE, MI 49024-4889
(269) 324-0799
(269) 324-8013
Mailing address
3200 W CENTRE AVE, SUITE 203, PORTAGE, MI 49024-4889
(269) 324-0799
(269) 324-8013
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601004477
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1151100074
BCBS
MI
01
—
2953900670
BLUE CROSS BLUE SHIELD
MI
05
—
4173074
—
MI
05
—
4179846
—
MI
Enumeration date
11/08/2006
Last updated
08/30/2022
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