Individual
DEIDRE ANNE DIETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3223 W 63RD STREET, CHICAGO, IL 60629
(773) 768-5000
Mailing address
9119 S EXCHANGE AVE, CHICAGO, IL 60617-4225
(773) 768-5000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036.125780
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RS2000-0373
TRAINING
NM
Enumeration date
06/22/2007
Last updated
09/07/2011
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