Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 036153226 | IL |
N | 204F00000X | Transplant Surgeon | A155080 | CA |
N | 208200000X | Surgeon | A155080 | CA |
N | 208600000X | Surgeon | A155080 | CA |
NPI | 1275832024 |
---|---|
Provider Name | Zachary Dietch |
First Address | Chicago, IL 60611-2927 |
Second Address | Chicago, IL 60611-2927 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2011 |
Last Update Date | 08/10/2020 |