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NPI Code Detail

MEDICARE: MR. DANIEL POLIN WIMSATT III MSW LCSW

MEDICARE: MR. DANIEL POLIN WIMSATT III MSW LCSW
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
11041C0700XClinical Social Worker149012429IL

General Provider Information

NPI Number : 1952485963
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DANIEL POLIN WIMSATT III MSW LCSW
Provider Business Mailing Address
First Line : 2819 N CAMBRIDGE AVE
Second Line : #3S
City : CHICAGO
State : IL
Zip : 60657-6075
Country : US
Telephone Number : 773-414-3565
Fax Number :
Provider Business Practice Location Address
First Line : 2755 N PINE GROVE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60614-6109
Country : US
Telephone Number : 773-414-3565
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2006
Last Update Date : 12/02/2010

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