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Contact Information

ILITCH DIAZ GUTIERREZ, MD
1655 BEAM AVE STE 302
MAPLEWOOD, MN55109-1477
 Phone: 651-227-6351
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Thoracic Surgery (Cardiothoracic Vascular Surgery)

208G00000X 02 Physician/General Surgery
 

Surgery

208600000X 02 Physician/General Surgery
Indicates primary specialty

NPI Profile & details for ILITCH DIAZ GUTIERREZ · (Male)

NPI # 1629209366
Status Active
Credentials MD
Entity Individual
Enumeration date 07/29/2009
Last updated 08/30/2018 - About 8 years ago
Sole proprietor 1 Yes
Identifiers
  • MN License # 63088
  • NM License # RS2009-0378
Hospital affiliation(s)
  • UNIVERSITY OF MINNESOTA MEDICAL CENTER FAIRVIEW - (Acute Care)
    2450 RIVERSIDE AVENUE
    MINNEAPOLIS, MN 55454
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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