Provider Demographics
NPI:1922007418
Name:ALANIS, DIANA ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:ELIZABETH
Last Name:ALANIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DIANA
Other - Middle Name:ELIZABETH
Other - Last Name:ORTEGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:461 N MULFORD RD STE 3
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5165
Mailing Address - Country:US
Mailing Address - Phone:815-227-9594
Mailing Address - Fax:815-227-9574
Practice Address - Street 1:461 N MULFORD RD STE 3
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5165
Practice Address - Country:US
Practice Address - Phone:815-227-9594
Practice Address - Fax:815-227-9574
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109226207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3625485496111001Medicaid
IL3625485496111001Medicaid