Provider Demographics
NPI:1063420321
Name:GERBER, DIANE L (MD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:L
Last Name:GERBER
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 1:250 E PEARSON ST
Mailing Address - Street 2:#2803
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-7225
Mailing Address - Country:US
Mailing Address - Phone:312-280-8707
Mailing Address - Fax:
Practice Address - Street 1:250 E PEARSON ST
Practice Address - Street 2:#2803
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-7225
Practice Address - Country:US
Practice Address - Phone:312-280-8707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036057390208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL697050Medicare ID - Type Unspecified
ILD15089Medicare UPIN