Healthcare Provider Details

I. General information

NPI: 1528090164
Provider Name (Legal Business Name): RICHARD ROBERT DILORENZO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 E LAKE SHORE DR
DECATUR IL
62521-3809
US

IV. Provider business mailing address

1730 E LAKE SHORE DR
DECATUR IL
62521-3809
US

V. Phone/Fax

Practice location:
  • Phone: 217-329-1000
  • Fax:
Mailing address:
  • Phone: 217-329-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036085835
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: