Provider Demographics
NPI:1477188449
Name:SAWICKI, DALIA
Entity Type:Individual
Prefix:
First Name:DALIA
Middle Name:
Last Name:SAWICKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 WEST 95TH STREET
Mailing Address - Street 2:ASHU
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453
Mailing Address - Country:US
Mailing Address - Phone:708-684-8000
Mailing Address - Fax:708-684-1987
Practice Address - Street 1:4440 WEST 95TH STREET
Practice Address - Street 2:ASHU
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453
Practice Address - Country:US
Practice Address - Phone:708-684-8000
Practice Address - Fax:708-684-1987
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021095363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILPENDINGMedicaid