Provider Demographics
NPI:1336374669
Name:AVELLA PATINO, DIEGO MAURICIO (MD)
Entity Type:Individual
Prefix:
First Name:DIEGO
Middle Name:MAURICIO
Last Name:AVELLA PATINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:675 N SAINT CLAIR ST FL 17
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5975
Mailing Address - Country:US
Mailing Address - Phone:312-695-3800
Mailing Address - Fax:312-695-4741
Practice Address - Street 1:675 N SAINT CLAIR ST FL 17
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5975
Practice Address - Country:US
Practice Address - Phone:312-695-3800
Practice Address - Fax:312-695-4741
Is Sole Proprietor?:No
Enumeration Date:2009-05-15
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036135823208G00000X, 208G00000X
MO2017025961208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)