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General NPI Number Information
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NPI Number | 1245374875
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Entity Type | Organization
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Legal Business Name | DIANE L OZOG, MDSC
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 10/30/2018
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Provider Practice Location Address
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Address Line | 1331 W 75TH ST STE 303
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City | NAPERVILLE
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State | IL
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Zip | 60540-9311
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Country | US
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Telephone | 630-652-0606
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Fax | 630-652-9900
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Provider Business Mailing Address
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Address Line | 1331 W 75TH ST STE 303
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City | NAPERVILLE
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State | IL
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Zip | 60540-9311
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Country | US
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Telephone | 630-652-0606
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Fax | 630-652-9900
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Authorized Official
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Title or Position | PRESIDENT
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Name | DIANE L OZOG
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Credential |
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Telephone | 630-652-0606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 042006736
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License Number State | IL
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