Healthcare Provider Details

I. General information

NPI: 1457387334
Provider Name (Legal Business Name): RICHARD M DSIDA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 EAST CHICAGO AVE DEPARTMENT OF ANESTHESIA
CHICAGO IL
60611
US

IV. Provider business mailing address

225 EAST CHICAGO AVE BOX 19
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-5170
  • Fax: 312-227-9730
Mailing address:
  • Phone: 312-227-5170
  • Fax: 312-227-9730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number036073715
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: