Provider Demographics
NPI:1366490054
Name:CALAMARAS, DIANE M (RN CPNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:CALAMARAS
Suffix:
Gender:F
Credentials:RN CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1252 W CATALPA
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1337
Mailing Address - Country:US
Mailing Address - Phone:773-728-8953
Mailing Address - Fax:
Practice Address - Street 1:2300 CHILDRENS PLAZA
Practice Address - Street 2:BOX #30
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3394
Practice Address - Country:US
Practice Address - Phone:773-868-8953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209002438208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q62439Medicare UPIN
ILK24628Medicare ID - Type Unspecified