Provider Demographics
NPI:1801422704
Name:DIAZ, LUCERO (MD)
Entity type:Individual
Prefix:
First Name:LUCERO
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15300 WEST AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4508
Mailing Address - Country:US
Mailing Address - Phone:708-590-5304
Mailing Address - Fax:708-590-5308
Practice Address - Street 1:15300 WEST AVE STE 120
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4508
Practice Address - Country:US
Practice Address - Phone:708-590-5304
Practice Address - Fax:708-590-5308
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036170987207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology