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NPI Code Detail

MEDICARE: DIAMOND HEADACHE CLINIC LTD

MEDICARE: DIAMOND HEADACHE CLINIC LTD
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
1174400000XSpecialist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11616611OTHERILBCBS

General Provider Information

NPI Number : 1912027665
Entity Type Code : Organization
Provider Name (Legal Business Name) : DIAMOND HEADACHE CLINIC LTD
Provider Business Mailing Address
First Line : 1460 N HALSTED ST STE 501
Second Line :
City : CHICAGO
State : IL
Zip : 60642-2615
Country : US
Telephone Number : 773-388-6390
Fax Number : 312-867-7101
Provider Business Practice Location Address
First Line : 1460 N HALSTED ST STE 501
Second Line :
City : CHICAGO
State : IL
Zip : 60642-2615
Country : US
Telephone Number : 773-388-6390
Fax Number : 312-867-7101
Authorized Official
Title or Position : MANAGING DIRECTOR
Name : DR. MERLE L DIAMOND
Credential : MD
Telephone Number : 773-388-6390
Provider Enumeration Date : 03/29/2007
Last Update Date : 12/26/2017

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Directions to “DIAMOND HEADACHE CLINIC LTD ” Practice Location

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