MEDICARE: CLAUDIO J DIAZ MD PA

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
1	2084N0400X	Neurology Physician	ME0015799	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	207681	OTHER	FL	AMERIGROUP

General Provider Information

NPI Number	:	1447291372
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLAUDIO J DIAZ MD PA

Provider Business Mailing Address
First Line	:	PO BOX 650870
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165
Country	:	US
Telephone Number	:	305-551-7468
Fax Number	:	305-551-7527

Provider Business Practice Location Address
First Line	:	10101 SW 40TH STREET
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165
Country	:	US
Telephone Number	:	305-551-7468
Fax Number	:	305-551-7527

Authorized Official
Title or Position	:	OWNER
Name	:	MR. CLAUDIO J DIAZ
Credential	:	MD
Telephone Number	:	305-551-7468

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	12/26/2007

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