Individual
DR. DIANA O. IWANIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7435 W. TALCOTT AVENUE, PRESENCE RMC, RADIOLOGY DEPARTMENT, CHICAGO, IL 60631-3745
(773) 990-7684
(773) 792-5124
Mailing address
7435 W. TALCOTT AVENUE, PRESENCE RMC, RADIOLOGY DEPARTMENT, CHICAGO, IL 60631-3745
(773) 990-7684
(773) 792-5124
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
036072868
IL
2085N0700X
Neuroradiology Physician
036072868
IL
2085N0904X
Nuclear Radiology Physician
036072868
IL
2085P0229X
Pediatric Radiology Physician
036072868
IL
2085R0202X
Diagnostic Radiology Physician
Primary
036072868
IL
2085U0001X
Diagnostic Ultrasound Physician
036072868
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001619902
BLUE CROSS BLUE SHIELD-IL
IL
05
—
036072868
—
IL
05
—
036072868-2
—
IL
Enumeration date
07/17/2006
Last updated
03/31/2021
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