MEDICARE: DIRSI, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1407453236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIRSI, INC

Provider Business Mailing Address
First Line	:	2112 N DAYTON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-4302
Country	:	US
Telephone Number	:	312-843-4340
Fax Number	:

Provider Business Practice Location Address
First Line	:	2112 N DAYTON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-4302
Country	:	US
Telephone Number	:	312-843-4340
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	DR. AMY ZIER
Credential	:	PHD
Telephone Number	:	312-843-4340

Provider Enumeration Date	:	10/05/2020
Last Update Date	:	10/05/2020

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Directions to “DIRSI, INC ” Practice Location

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