Provider Demographics
NPI:1912934423
Name:DIAKOS, BARBARA (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:DIAKOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 N HALSTED ST
Mailing Address - Street 2:SUITE 503
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-2605
Mailing Address - Country:US
Mailing Address - Phone:773-472-1444
Mailing Address - Fax:312-787-4424
Practice Address - Street 1:9660 WICKER AVE FL 2
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-9487
Practice Address - Country:US
Practice Address - Phone:219-226-2236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036086553207V00000X
IN01082757A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036086553Medicaid
IL1620171OtherBLUE CROSS BLUE SHIELD
L39109Medicare ID - Type Unspecified
F83110Medicare UPIN