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General NPI Number Information
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NPI Number | 1497150486
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Entity Type | Individual
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Provider Name | DIANE MARIA LESS PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/03/2014
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Last Update Date | 11/03/2014
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Provider Practice Location Address
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Address Line | 1900 W POLK ST
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City | CHICAGO
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State | IL
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Zip | 60612-3723
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Country | US
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Telephone | 312-864-0224
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Fax | 312-864-9658
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Provider Business Mailing Address
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Address Line | 14 W ELM ST APT 1704
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City | CHICAGO
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State | IL
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Zip | 60610-7132
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Country | US
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Telephone | 630-341-5217
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085005150
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License Number State | IL
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