Provider Demographics
NPI:1144215708
Name:KRALL, DIANE C (MD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:C
Last Name:KRALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:105 S LOCUST ST
Mailing Address - Street 2:PO BOX 187
Mailing Address - City:TREMONT
Mailing Address - State:IL
Mailing Address - Zip Code:61568-9572
Mailing Address - Country:US
Mailing Address - Phone:309-925-2961
Mailing Address - Fax:309-925-4221
Practice Address - Street 1:105 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:TREMONT
Practice Address - State:IL
Practice Address - Zip Code:61568-0187
Practice Address - Country:US
Practice Address - Phone:309-925-2961
Practice Address - Fax:309-925-4221
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036111933207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00253527OtherRAILROAD MEDICARE
IL9015656OtherBCBS
IL9015656OtherBCBS
ILK19600Medicare PIN