Provider Demographics
NPI:1881655140
Name:DIACONESCU, ELIZA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZA
Middle Name:
Last Name:DIACONESCU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 TOWER CT
Mailing Address - Street 2:STE 140
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3338
Mailing Address - Country:US
Mailing Address - Phone:847-672-4543
Mailing Address - Fax:847-249-3001
Practice Address - Street 1:15 TOWER CT
Practice Address - Street 2:STE 140
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3338
Practice Address - Country:US
Practice Address - Phone:847-672-4543
Practice Address - Fax:847-249-3001
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036084312207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK18658/ K18659Medicare ID - Type UnspecifiedLAKE COUNTY/COOK COUNTY