Organization
M D AESTHETICS AND DERMATOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GABRIEL J. MARTINEZ-DIAZ M.D. (MEDICAL DIRECTOR/DERMATOLOGIST)
(312) 579-0700
Entity
Organization
Contact information
Practice address
1021 W ADAMS ST, LL # 1, CHICAGO, IL 60607-2934
(312) 579-0700
(312) 579-0701
Mailing address
1021 W. ADAMS ST., LL #1, CHICAGO, IL 60607
(312) 579-0700
(312) 579-0701
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
036138747
IL
207ND0101X
MOHS-Micrographic Surgery Physician
036138747
IL
207NS0135X
Procedural Dermatology Physician
036138747
IL
Other
Enumeration date
09/13/2017
Last updated
07/21/2022
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