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NPI Code Detail

MEDICARE: JOSE A DIAZ M.D.

MEDICARE: JOSE A DIAZ M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery Physician036.077861IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1982693271
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSE A DIAZ M.D.
Provider Business Mailing Address
First Line : 12860 TROXLER AVE
Second Line :
City : HIGHLAND
State : IL
Zip : 62249-2898
Country : US
Telephone Number : 618-664-9831
Fax Number :
Provider Business Practice Location Address
First Line : 12860 TROXLER AVE
Second Line :
City : HIGHLAND
State : IL
Zip : 62249-2898
Country : US
Telephone Number : 618-664-9831
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2005
Last Update Date : 11/08/2022

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