Provider Demographics
NPI:1861481244
Name:DIAMOND, STEVEN D (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:D
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5727 STRATHMOOR DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5180
Mailing Address - Country:US
Mailing Address - Phone:815-397-3337
Mailing Address - Fax:815-231-5408
Practice Address - Street 1:5727 STRATHMOOR DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5180
Practice Address - Country:US
Practice Address - Phone:815-397-3337
Practice Address - Fax:815-231-5408
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036376054207Q00000X
WI28756020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI82082300OtherWISE PUBLICAID
B52422Medicare UPIN
201415Medicare ID - Type Unspecified