Individual
PAUL DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2133 W LEXINGTON ST, CHICAGO, IL 60612-3707
(312) 746-7824
(312) 746-6526
Mailing address
333 S STATE ST, CHICAGO, IL 60604-3900
(312) 747-9545
(312) 745-7603
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
001159
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001159
IDPHLICENSE
IL
Enumeration date
07/20/2016
Last updated
07/20/2016
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