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General NPI Number Information
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NPI Number | 1609526987
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Entity Type | Individual
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Provider Name | DIEGO ALFONSO VALENZUELA III MD
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Gender | Male
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Dates
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Enumeration Date | 03/28/2022
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 5841 S. MARYLAND AVE. M/C 5100
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City | CHICAGO
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State | IL
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Zip | 60637-1443
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Country | US
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Telephone | 773-702-3630
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Fax | 773-753-8301
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Provider Business Mailing Address
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Address Line | 180 HARVESTER DR STE 110
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City | BURR RIDGE
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State | IL
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Zip | 60527-6686
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Country | US
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Telephone | 773-702-1150
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 1609526987
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 036.175197
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 036.175197
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License Number State | IL
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