Provider Demographics
NPI:1578596227
Name:ZUG, DIANE HELEN (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:HELEN
Last Name:ZUG
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 1:6830 VILLAGREEN VW
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5639
Mailing Address - Country:US
Mailing Address - Phone:815-282-1339
Mailing Address - Fax:815-282-1298
Practice Address - Street 1:6830 VILLAGREEN VW
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5639
Practice Address - Country:US
Practice Address - Phone:815-282-1339
Practice Address - Fax:815-282-1298
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00434019OtherRR MEDICARE PTAN NUMBER
ILCC5050OtherRR MEDICARE GROUP NUMBER
ILK29422Medicare ID - Type Unspecified
IL846930Medicare ID - Type UnspecifiedMEDICARE GROUP #
ILP00434019OtherRR MEDICARE PTAN NUMBER
ILI57187Medicare UPIN
ILK29423Medicare ID - Type Unspecified