Healthcare Provider Details

I. General information

NPI: 1851387096
Provider Name (Legal Business Name): DIANE HOMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 OGDEN AVE SUITE 330
AURORA IL
60504-5894
US

IV. Provider business mailing address

2020 OGDEN AVE STE 400
AURORA IL
60504-5898
US

V. Phone/Fax

Practice location:
  • Phone: 630-978-4850
  • Fax: 630-978-6865
Mailing address:
  • Phone: 630-692-5563
  • Fax: 630-692-5564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-074674
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: