Individual
DR. DIANE MARIE MATER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
840 E MOUNT HOPE AVE, LANSING, MI 48910-3293
(517) 853-3704
Mailing address
3955 PATIENT CARE WAY, SUITE A, LANSING, MI 48911-4299
(517) 374-7600
(517) 374-9042
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101017172
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1932316114
—
MI
01
—
853303755
BCBS PIN
MI
01
—
9836558
AETNA ID
MI
Enumeration date
05/17/2007
Last updated
10/28/2010
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