Provider Demographics
NPI:1245556695
Name:MARTINEZ-DIAZ, GABRIEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:J
Last Name:MARTINEZ-DIAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 W ADAMS ST STE LL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2934
Mailing Address - Country:US
Mailing Address - Phone:312-579-0700
Mailing Address - Fax:312-579-0701
Practice Address - Street 1:1021 W. ADAMS ST.
Practice Address - Street 2:L L # 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607
Practice Address - Country:US
Practice Address - Phone:312-579-0700
Practice Address - Fax:312-579-0701
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036138747207NS0135X, 207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty