Healthcare Provider Details

I. General information

NPI: 1265748008
Provider Name (Legal Business Name): DALE SWIMS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5345 N SHERIDAN RD 1ST FL.
CHICAGO IL
60640-2531
US

IV. Provider business mailing address

2740 W FOSTER AVE STE LL7
CHICAGO IL
60625-3543
US

V. Phone/Fax

Practice location:
  • Phone: 773-293-8890
  • Fax: 773-293-8895
Mailing address:
  • Phone: 773-878-8200
  • Fax: 773-293-4197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036133679
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: