Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ilitch Diaz Gutierrez, MD

Individual provider Surgery Physician · NPI 1629209366

Ilitch Diaz Gutierrez, MD is a Thoracic Surgery in Maplewood, Minnesota. Qualified in 2007, 19 years ago. Practices with Fairview Express Care, a 1,964-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Minnesota and New Mexico.

Years since qualifying
19
Licensed in
MN, NM
In the registry since
2009
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1655 Beam Ave Ste 302
Maplewood, MN 55109-1477
Phone: (651) 227-6351
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 500 Harvard St Se, Minneapolis, MN 55455-0363 — (612) 273-3000

Specialties & licences

Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician (primary) Taxonomy 208G00000X · Licence 63088 (MN)
Surgery Physician Taxonomy 208600000X · Licence RS2009-0378 (NM)

Record details

NPI number1629209366
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedJuly 29, 2009
Last updated in NPPESAugust 30, 2018
Mailing address3144 Chowen Ave S, Apt 219b, Minneapolis, MN 55416-5398

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyTHORACIC SURGERY
Medical schoolOTHER
Graduated 2007 (19 years in practice)
Group practice Fairview Express Care — 1964 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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