Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 036060387 | IL |
Y | 207RP1001X | Pulmonary Disease | 036060387 | IL |
NPI | 1033161518 |
---|---|
Provider Name | Edward J Diamond |
First Address | Elk Grove Village, IL 60007-3311 |
Second Address | Elk Grove Village, IL 60007-3311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 05/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036060387 | (05) | IL |
1617373 | BCBS OF IL (01) | IL |
C43120 | (02) | IL |