Provider Demographics
NPI:1003024175
Name:RAPAPORT, DIANE GALE (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:GALE
Last Name:RAPAPORT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2645 CRESTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:RIVERWOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1904
Mailing Address - Country:US
Mailing Address - Phone:847-374-1933
Mailing Address - Fax:847-374-8866
Practice Address - Street 1:580 WATERS EDGE
Practice Address - Street 2:SUITE 100
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6430
Practice Address - Country:US
Practice Address - Phone:630-495-8484
Practice Address - Fax:630-495-1598
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2021-03-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036064871207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD15268Medicare UPIN