Provider Demographics
NPI:1417178179
Name:VALLEY RHEUMATOLOGY ASSOCIATES, PLLC
Entity type:Organization
Organization Name:VALLEY RHEUMATOLOGY ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:DIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-791-4657
Mailing Address - Street 1:4701 TOWNE CENTRE RD
Mailing Address - Street 2:MEDICAL ARTS #2 STE 101
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2834
Mailing Address - Country:US
Mailing Address - Phone:989-791-4657
Mailing Address - Fax:989-791-4651
Practice Address - Street 1:4701 TOWNE CENTRE RD
Practice Address - Street 2:MEDICAL ARTS #2 SUITE 101
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2834
Practice Address - Country:US
Practice Address - Phone:989-791-4657
Practice Address - Fax:989-791-4651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICD077266207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIBLUECARE NETWORKOther1107310671
MI0990090OtherHEALTH PLUS
MI4568334Medicaid
MI5043138OtherAETNA
MI=========OtherCOMMERCIAL
MIBLUECARE NETWORKOther1107310671
MIG07572Medicare UPIN