Healthcare Provider Details

I. General information

NPI: 1760379895
Provider Name (Legal Business Name): DIEGO ALMEIDA DE SOUZA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 S 1ST AVE
MAYWOOD IL
60153-3328
US

IV. Provider business mailing address

435 S GROVE AVE APT 3S
OAK PARK IL
60302-4905
US

V. Phone/Fax

Practice location:
  • Phone: 708-216-2687
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number125085289
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: