Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 036138747 | IL |
N | 207NS0135X | Procedural Dermatology | 036138747 | IL |
NPI | 1245556695 |
---|---|
Provider Name | Dr. Gabriel J Martinez-Diaz |
First Address | Chicago, IL 60607-2934 |
Second Address | Chicago, IL 60607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2010 |
Last Update Date | 06/12/2021 |