Provider Demographics
NPI:1952759516
Name:DWYER, RICHARD CASSIDY (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CASSIDY
Last Name:DWYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 W CONGRESS PKWY APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3809
Mailing Address - Country:US
Mailing Address - Phone:312-942-4200
Mailing Address - Fax:
Practice Address - Street 1:1717 W CONGRESS PKWY APT 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3809
Practice Address - Country:US
Practice Address - Phone:312-942-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1952759516207R00000X
IL036148405207R00000X, 208M00000X
IL125.068621390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program