Provider Demographics
NPI:1851656516
Name:DE LEON, DIANNE A (MD)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:A
Last Name:DE LEON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4732 N LINCOLN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-8561
Mailing Address - Country:US
Mailing Address - Phone:312-695-8106
Mailing Address - Fax:312-694-7291
Practice Address - Street 1:4732 N LINCOLN AVE STE 200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-8561
Practice Address - Country:US
Practice Address - Phone:312-695-8106
Practice Address - Fax:312-694-7291
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA266092207N00000X
IL036158125207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology