Diana T Widicus, MD
Individual provider Active NPI Family Medicine Physician · Rochester, IL
NPI 1851471072 · NPPES record last updated Dec 30, 2021
Key facts
- NPI
- 1851471072
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 36062017 (IL)
- Practice address
- 300 Sattley St
Rochester, IL 62563-9241 - Phone
- (217) 789-3630
- Fax
- (217) 498-6812
- NPI assigned
- Oct 16, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36062017 | IL | MD | Family Medicine Physician |
Interoperability endpoints
- dwidicus33278@ewd.direct.hshs.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 36062017 | IL | Yes |
Addresses
Primary practice location
300 Sattley St
Rochester, IL 62563-9241
Mailing address
1836 South Macarthur Blvd
Springfield, IL 62704
Phone (217) 789-1403
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8415046 | Other | IL | BCBS |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | dwidicus33278@ewd.direct.hshs.org | Direct |
Other providers in Rochester, IL
- SLP Counseling Services
- Cheryl Sue Swenny
- Matthew Jules Swenny
- The Rooted Wellness Group PLLC
- Catherine Mary Chrietzberg Wells
- Douglas Allen Zobrist
All providers in Rochester, IL · Family Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 30, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.