Individual
DIANA KERATISHVILI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
355 RIDGE AVE, EVANSTON, IL 60202-3328
(847) 316-4000
Mailing address
419 RIDGE AVE APT E, EVANSTON, IL 60202-2852
(224) 223-5638
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
125082773
IL
Other
Enumeration date
07/20/2023
Last updated
07/20/2023
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