Individual
DR. ROBERT CHARLES DEZANEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
5916 W HIGGINS AVE, CHICAGO, IL 60630-1905
(773) 283-1911
Mailing address
5916 W HIGGINS AVE, CHICAGO, IL 60630-1905
(773) 283-1911
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0060001570
BLUE CROSS
IL
Enumeration date
10/22/2007
Last updated
10/22/2007
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