| Doctor Name: | DR. DIANE THALER |
| NPI Number: | 1902868490 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 23517020 |
| Business Practice Address: | 33 Green Bay Rd Sturgeon Bay, WI - 542352831 |
| Business Phone Number: | 9206835278 |
| Business Fax Number: | 9206869674 |
| Mailing Address: | 801 York St, MANITOWOC |
| State: | WI |
| Postal Code: | 542204630 |
| Phone Number: | 9206835278 |
| Fax Number: | 9206869674 |
| NPI Enumeration Date: | 04/03/2006 |
| NPI Last Update Date: | 03/17/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 23517020 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WI |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |