Individual
DALE SWIMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
5345 N SHERIDAN RD, 1ST FL., CHICAGO, IL 60640-2531
(773) 293-8890
(773) 293-8895
Mailing address
2740 W FOSTER AVE, STE LL7, CHICAGO, IL 60625-3543
(773) 878-8200
(773) 293-4197
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036133679
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036133679
—
IL
01
—
125057797
STATE LICENSE
IL
01
—
406120
MEDICARE PTAN FOR SCMG
IL
01
—
F400098252
MEDICARE INDIVIDUAL PTAN
IL
Enumeration date
08/30/2010
Last updated
10/30/2020
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