Provider Demographics
NPI:1609825447
Name:DIAMOND, TERRENCE P (MD)
Entity Type:Individual
Prefix:MR
First Name:TERRENCE
Middle Name:P
Last Name:DIAMOND
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Gender:M
Credentials:MD
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Mailing Address - Street 1:10604 SOUTHWEST HIGHWAY
Mailing Address - Street 2:STE 107
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-2717
Mailing Address - Country:US
Mailing Address - Phone:708-422-0636
Mailing Address - Fax:708-424-2164
Practice Address - Street 1:10604 SOUTHWEST HIGHWAY
Practice Address - Street 2:STE 107
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-2717
Practice Address - Country:US
Practice Address - Phone:708-422-0636
Practice Address - Fax:708-424-2164
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2021-12-08
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Provider Licenses
StateLicense IDTaxonomies
IN01061295207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INC43681Medicare UPIN