Healthcare Provider Details

I. General information

NPI: 1619133212
Provider Name (Legal Business Name): DAVID DRELICHARZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2008
Last Update Date: 09/29/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 N HALSTED ST SUITE 402
CHICAGO IL
60642-2605
US

IV. Provider business mailing address

1460 N HALSTED ST SUITE 402
CHICAGO IL
60642-2605
US

V. Phone/Fax

Practice location:
  • Phone: 312-279-8900
  • Fax:
Mailing address:
  • Phone: 312-227-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.123843
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: