Provider Demographics
NPI:1053388447
Name:DIAKOW, LILIAN M (MD)
Entity type:Individual
Prefix:DR
First Name:LILIAN
Middle Name:M
Last Name:DIAKOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183
Mailing Address - Country:US
Mailing Address - Phone:734-676-0026
Mailing Address - Fax:
Practice Address - Street 1:1539 FORD AVE
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192
Practice Address - Country:US
Practice Address - Phone:734-282-8414
Practice Address - Fax:734-285-7855
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301024223207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
08222211OtherBCN
1608222211OtherBCBSM
5820465OtherAETNA
H55502OtherHAP
MI4251958Medicaid
1608222211OtherBCBSM
B44761Medicare UPIN
5820465OtherAETNA
H55502OtherHAP