Provider Demographics
NPI:1710958673
Name:KRAFT, DIANA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:MARIE
Last Name:KRAFT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:331 GREENWOOD ACRES DR
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115
Mailing Address - Country:US
Mailing Address - Phone:815-748-5175
Mailing Address - Fax:
Practice Address - Street 1:8 HEALTH SERVICES DR
Practice Address - Street 2:SUITE 4
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-9647
Practice Address - Country:US
Practice Address - Phone:815-748-8334
Practice Address - Fax:815-748-8921
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
BK0362690OtherDEA