Basic Information
| Provider Information | |||||||||
| NPI: | 1265748008 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SWIMS | ||||||||
| FirstName: | DALE | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2740 W FOSTER AVE | ||||||||
| Address2: | STE LL7 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606253543 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738788200 | ||||||||
| FaxNumber: | 7732934197 | ||||||||
| Practice Location | |||||||||
| Address1: | 5345 N SHERIDAN RD | ||||||||
| Address2: | 1ST FL. | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606402531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732938890 | ||||||||
| FaxNumber: | 7732938895 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2010 | ||||||||
| LastUpdateDate: | 10/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036133679 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 406120 | 01 | IL | MEDICARE PTAN FOR SCMG | OTHER | F400098252 | 01 | IL | MEDICARE INDIVIDUAL PTAN | OTHER | 125057797 | 01 | IL | STATE LICENSE | OTHER | 036133679 | 05 | IL | MEDICAID |