Provider Demographics
NPI:1942289764
Name:DIRKES, RICHARD V (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:V
Last Name:DIRKES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:276 W FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-3767
Mailing Address - Country:US
Mailing Address - Phone:630-543-5454
Mailing Address - Fax:630-543-5471
Practice Address - Street 1:276 W FULLERTON AVE
Practice Address - Street 2:ADDISON MEDICAL ASSOACIATES
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-3767
Practice Address - Country:US
Practice Address - Phone:630-543-5454
Practice Address - Fax:630-543-5471
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-054771207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036054771Medicaid
IL036054771Medicaid
IL036054771Medicaid