Provider Demographics
NPI:1134126949
Name:NIELSEN, DIANE C (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:C
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2800 KESLINGER RD STE 160
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-3753
Mailing Address - Country:US
Mailing Address - Phone:630-232-7200
Mailing Address - Fax:630-232-2288
Practice Address - Street 1:2800 KESLINGER RD STE 160
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-3753
Practice Address - Country:US
Practice Address - Phone:630-232-7200
Practice Address - Fax:630-232-2288
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2020-05-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036084404208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF43036Medicare UPIN