Provider Demographics
NPI:1265748008
Name:SWIMS, DALE (DO)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:
Last Name:SWIMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2740 W FOSTER AVE
Mailing Address - Street 2:STE LL7
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3543
Mailing Address - Country:US
Mailing Address - Phone:773-878-8200
Mailing Address - Fax:773-293-4197
Practice Address - Street 1:5345 N SHERIDAN RD
Practice Address - Street 2:1ST FL.
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2531
Practice Address - Country:US
Practice Address - Phone:773-293-8890
Practice Address - Fax:773-293-8895
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036133679207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL406120OtherMEDICARE PTAN FOR SCMG
ILF400098252OtherMEDICARE INDIVIDUAL PTAN
IL125057797OtherSTATE LICENSE
IL036133679Medicaid
IL036133679Medicaid