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Individual

DR. JACINTO ANTONIO V DIZON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1211 S PRAIRIE AVE, SUITE 5505, CHICAGO, IL 60605
(847) 212-9809
Mailing address
1211 S PRAIRIE AVE, SUITE 5505, CHICAGO, IL 60605-3645
(847) 212-9809

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
36085219
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
36085219
IL
Enumeration date
02/01/2007
Last updated
06/11/2018
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