Provider Demographics
NPI:1740259365
Name:DIEKEVERS, DOUGLAS A (DPM)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:A
Last Name:DIEKEVERS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 N HALSTED ST STE 525
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-9269
Mailing Address - Country:US
Mailing Address - Phone:773-433-3130
Mailing Address - Fax:440-716-1605
Practice Address - Street 1:3000 HALSTED ST
Practice Address - Street 2:SUITE 525
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-5902
Practice Address - Country:US
Practice Address - Phone:773-433-3130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004442213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00251740OtherRAILROAD MEDICARE
IL60010806OtherBLUE CROSS BLUE SHIELD
IL93662603OtherUNITED HEALTHCARE
IL016004442Medicaid
IL016004442Medicaid
ILP00251740OtherRAILROAD MEDICARE