Provider Demographics
NPI:1013004639
Name:DIAZ, ELIZABETH P (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:P
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7447 W TALCOTT AVE
Mailing Address - Street 2:SUITE 269
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3745
Mailing Address - Country:US
Mailing Address - Phone:773-792-2727
Mailing Address - Fax:773-792-2776
Practice Address - Street 1:7447 W TALCOTT AVE
Practice Address - Street 2:SUITE 269
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3745
Practice Address - Country:US
Practice Address - Phone:773-792-2727
Practice Address - Fax:773-792-2776
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036059322363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AD8968363OtherDEA
AD8968363OtherDEA