Provider Demographics
NPI:1194126573
Name:HD MEDSPA & CLINIC
Entity type:Organization
Organization Name:HD MEDSPA & CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-770-6300
Mailing Address - Street 1:3615 N ASHLAND AVE
Mailing Address - Street 2:STE 1N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-4789
Mailing Address - Country:US
Mailing Address - Phone:773-770-6300
Mailing Address - Fax:773-665-5007
Practice Address - Street 1:3615 N ASHLAND AVE
Practice Address - Street 2:STE 1N
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-4789
Practice Address - Country:US
Practice Address - Phone:773-770-6300
Practice Address - Fax:773-665-5007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1908417207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty