| Diamond Gastroenterology Sc | |
|
1010 Lake St Ste 424 Oak Park IL 60301-1185 | |
| (708) 613-4417 | |
| Not Available |
| Full Name | Diamond Gastroenterology Sc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1010 Lake St Ste 424, Oak Park, Illinois |
| Authorized Official Name and Position | Ilysa Diamond (OWNER) |
| Authorized Official Contact | 7086134417 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Diamond Gastroenterology Sc 1010 Lake St Ste 424 Oak Park IL 60301-1185 Ph: (708) 613-4417 | Diamond Gastroenterology Sc 1010 Lake St Ste 424 Oak Park IL 60301-1185 Ph: (708) 613-4417 |
| NPI Number | 1043624752 |
|---|---|
| Provider Enumeration Date | 06/20/2014 |
| Last Update Date | 08/02/2023 |
| Medicare PECOS PAC ID | 8022235837 |
|---|---|
| Medicare Enrollment ID | O20140818002229 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043624752 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | 36120184 (Illinois) | Primary |
| Provider Name | Ilysa R Diamond |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1356596332 PECOS PAC ID: 6204998396 Enrollment ID: I20130429000632 |
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