Provider Demographics
NPI:1144356213
Name:JAIME, DIANA JULIA (MD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:JULIA
Last Name:JAIME
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 COPPERFIELD AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60432-2056
Mailing Address - Country:US
Mailing Address - Phone:815-727-4292
Mailing Address - Fax:815-727-5395
Practice Address - Street 1:1301 COPPERFIELD AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60432-2056
Practice Address - Country:US
Practice Address - Phone:815-727-4292
Practice Address - Fax:815-727-5395
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336060372207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9928146OtherBC/BS
G97737Medicare UPIN
ILL95657Medicare PIN