Provider Demographics
NPI:1508078171
Name:FALTUSHANSKY, DIANA (MD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:FALTUSHANSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 SANDPEBBLE DR
Mailing Address - Street 2:APT. 226
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-5999
Mailing Address - Country:US
Mailing Address - Phone:847-520-1655
Mailing Address - Fax:847-520-7302
Practice Address - Street 1:544 W DUNDEE RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-2675
Practice Address - Country:US
Practice Address - Phone:847-419-6974
Practice Address - Fax:847-419-6982
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2011-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036122988207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine