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NPI Code Detail

MEDICARE: ELIEZER DIAZ D.O.

MEDICARE: ELIEZER DIAZ D.O.
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
1208D00000XGeneral Practice Physician125.086198IL

General Provider Information

NPI Number : 1972496925
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIEZER DIAZ D.O.
Provider Business Mailing Address
First Line : 5145 N CALIFORNIA AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60625-3661
Country : US
Telephone Number : 773-989-3808
Fax Number :
Provider Business Practice Location Address
First Line : 5145 N CALIFORNIA AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60625-3661
Country : US
Telephone Number : 773-989-3808
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2025
Last Update Date : 12/16/2025

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Directions to “ ELIEZER DIAZ D.O.” Practice Location

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