Provider Demographics
NPI:1942660758
Name:CANO MUJICA DE CHIRINOS, DIANA D (MD)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:D
Last Name:CANO MUJICA DE CHIRINOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:D
Other - Last Name:CANO MUJICA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:625 W MADISON ST APT 1008
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-2720
Mailing Address - Country:US
Mailing Address - Phone:312-909-3831
Mailing Address - Fax:
Practice Address - Street 1:625 W MADISON ST APT 1008
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-2720
Practice Address - Country:US
Practice Address - Phone:312-909-3831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125063555207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1447610233OtherNPI
IL1457383300929Medicare PIN