Provider Demographics
NPI:1316097942
Name:DIAB & KINNER INTERNAL MEDICINE, P.C.
Entity type:Organization
Organization Name:DIAB & KINNER INTERNAL MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLANN
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:KINNER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:586-558-4081
Mailing Address - Street 1:29703 HOOVER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-8901
Mailing Address - Country:US
Mailing Address - Phone:586-558-4081
Mailing Address - Fax:586-558-4099
Practice Address - Street 1:29703 HOOVER RD
Practice Address - Street 2:SUITE A
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2544
Practice Address - Country:US
Practice Address - Phone:586-558-4081
Practice Address - Fax:586-558-4099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110E013380OtherBCBSM
MI1316097942OtherHAP
MI1316097942Medicaid
MI0N54720Medicare PIN
MI1316097942Medicare PIN