MEDICARE: DR. DIANE L GERBER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	036057390	IL

General Provider Information

NPI Number	:	1063420321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANE L GERBER MD

Provider Business Mailing Address
First Line	:	250 E PEARSON ST
Second Line	:	#2803
City	:	CHICAGO
State	:	IL
Zip	:	60611-7225
Country	:	US
Telephone Number	:	312-280-8707
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 E PEARSON ST
Second Line	:	#2803
City	:	CHICAGO
State	:	IL
Zip	:	60611-7225
Country	:	US
Telephone Number	:	312-280-8707
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	01/05/2015

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