Basic Information
| Provider Information | |||||||||
| NPI: | 1053387274 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DICKLER | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2245 ENTERPRISE DR STE 4506 | ||||||||
| Address2: | |||||||||
| City: | WESTCHESTER | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601545803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084920502 | ||||||||
| FaxNumber: | 7084920565 | ||||||||
| Practice Location | |||||||||
| Address1: | 160 E ILLINOIS ST | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606115426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3125951444 | ||||||||
| FaxNumber: | 3124772391 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 12/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 036-107528 | IL | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 036107528 | 05 | IL | MEDICAID |