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NPI Code Detail

MEDICARE: NATASHA DIAZ MD

MEDICARE: NATASHA DIAZ MD
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
1207Q00000XFamily Medicine Physician036-113339IL

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 : 1659300408
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATASHA DIAZ MD
Provider Business Mailing Address
First Line : 5359 W FULLERTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60639-1450
Country : US
Telephone Number : 773-836-2785
Fax Number : 773-836-7381
Provider Business Practice Location Address
First Line : 5359 W FULLERTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60639-1450
Country : US
Telephone Number : 773-836-2785
Fax Number : 773-836-7381
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2006
Last Update Date : 12/30/2019

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Directions to “ NATASHA DIAZ MD” Practice Location

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