Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | IL |
NPI | 1255462578 |
---|---|
Provider Name | Dr. Roberto Diaz |
First Address | Chicago, IL 60608-2805 |
Second Address | Chicago, IL 60608-2805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 08/07/2007 |