Provider Demographics
NPI:1598322026
Name:DOTSON, DIANE LAKITA
Entity Type:Individual
Prefix:MISS
First Name:DIANE
Middle Name:LAKITA
Last Name:DOTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9211SO. LAFLIN
Mailing Address - Street 2:2A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-6504
Mailing Address - Country:US
Mailing Address - Phone:773-596-8500
Mailing Address - Fax:
Practice Address - Street 1:9211SO. LAFLIN
Practice Address - Street 2:2A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-6504
Practice Address - Country:US
Practice Address - Phone:773-596-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty