Basic Information
| Provider Information | |||||||||
| NPI: | 1528371929 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SILAS | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | REBECCA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 N LAFAYETTE ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH LYON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481782048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2484655140 | ||||||||
| FaxNumber: | 2484655141 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 N LAFAYETTE ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH LYON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481782048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2484655140 | ||||||||
| FaxNumber: | 2484655141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2010 | ||||||||
| LastUpdateDate: | 08/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 01933 | MI | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0005X | 510101864 | MI | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207X00000X | 510101864 | MI | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.