Individual ProviderDiane M VisichPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address211 S Crapo St, Suite A, Mount Pleasant, MI 48858-2961(989) 775-3823(989) 775-7641PECOS EnrollmentBased on the most recent information from CMS, provider Diane M Visich does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1023048055Provider TypeIndividualFull NameVisich, Diane MCredentialPAGenderFemaleSole ProprietorNoEnumeration Date7/4/2006Last Updated8/7/2008Contact InformationPractice LocationPractice Address211 S Crapo St, Suite A, Mount Pleasant, MI 48858-2961Phone(989) 775-3823Fax(989) 773-5061Mailing LocationMailing AddressPO Box 994, Alma, MI 48801-0994Phone(989) 775-7641Fax(989) 775-6472Provider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense5601003226MichiganProvider IdentifiersIDDescriptionIssuerID0853701290DescriptionOtherIssuerBCBSMMichigan