Provider Demographics
NPI:1316142383
Name:MISCH, DIANE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:MARIE
Last Name:MISCH
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 1:431 GREENLEAF AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1911
Mailing Address - Country:US
Mailing Address - Phone:847-920-1820
Mailing Address - Fax:847-920-1821
Practice Address - Street 1:1747 W ROOSEVELT RD
Practice Address - Street 2:M-C 747
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1264
Practice Address - Country:US
Practice Address - Phone:312-996-6219
Practice Address - Fax:312-996-9534
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry