Provider Demographics
NPI:1821101791
Name:IKE, DIANA U (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:U
Last Name:IKE
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 1:1015 HUNT CLUB CT
Mailing Address - Street 2:
Mailing Address - City:EXPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15632
Mailing Address - Country:US
Mailing Address - Phone:412-607-5270
Mailing Address - Fax:
Practice Address - Street 1:225 PENN AVE
Practice Address - Street 2:LIFECARE HOSP
Practice Address - City:PGH
Practice Address - State:PA
Practice Address - Zip Code:15221
Practice Address - Country:US
Practice Address - Phone:412-607-5270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA053270L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F92077Medicare UPIN
536739LSMMedicare ID - Type Unspecified