Healthcare Provider Details

I. General information

NPI: 1124956305
Provider Name (Legal Business Name): CASEY ALEXANDER DIMOV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CASE ALEXANDER DIMOV

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N MICHIGAN AVE STE 2550
CHICAGO IL
60611-3182
US

IV. Provider business mailing address

61 E 21ST ST UNIT 511
CHICAGO IL
60616-1732
US

V. Phone/Fax

Practice location:
  • Phone: 312-640-7740
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.129110
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: