MEDICARE: PETER A DODZIK PSY.D.

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	103TC0700X	Clinical Psychologist	20041718	IN
2	103TC0700X	Clinical Psychologist	071006408	IL
3	103G00000X	Clinical Neuropsychologist	071006408	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	680015841	OTHER	IN	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437156999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER A DODZIK PSY.D.

Provider Business Mailing Address
First Line	:	415 W GOLF RD STE 16
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-3923
Country	:	US
Telephone Number	:	847-577-0904
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 W GOLF RD STE 16
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-3923
Country	:	US
Telephone Number	:	847-577-0904
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	05/09/2022

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