Healthcare Provider Details

I. General information

NPI: 1245613520
Provider Name (Legal Business Name): PHILIP DWEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2015
Last Update Date: 07/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S PAULINA ST STE 140
CHICAGO IL
60612-3806
US

IV. Provider business mailing address

1409 N GREENVIEW AVE APT 3M
CHICAGO IL
60642-7617
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5865
  • Fax:
Mailing address:
  • Phone: 773-680-9558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036137876
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: