Individual
DIANE HELEN ZUG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6830 VILLAGREEN VW, ROCKFORD, IL 61107-5639
(815) 282-1339
(815) 282-1298
Mailing address
6830 VILLAGREEN VW, ROCKFORD, IL 61107-5639
(815) 282-1339
(815) 282-1298
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CC5050
RR MEDICARE GROUP NUMBER
IL
01
—
P00434019
RR MEDICARE PTAN NUMBER
IL
Enumeration date
07/08/2006
Last updated
01/28/2008
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