Healthcare Provider Details

I. General information

NPI: 1972600294
Provider Name (Legal Business Name): DIANE C. HILLARD-SEMBELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANE C. HILLARD

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N. 1ST STREET
SPRINGFIELD IL
62702
US

IV. Provider business mailing address

1025 S 6TH ST
SPRINGFIELD IL
62703-2403
US

V. Phone/Fax

Practice location:
  • Phone: 217-528-7541
  • Fax:
Mailing address:
  • Phone: 217-528-7541
  • Fax: 217-528-8962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number036076412
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036-076412
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: