Healthcare Provider Details

I. General information

NPI: 1730778549
Provider Name (Legal Business Name): ALEXANDRA DILLMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXANDRA KATHLEEN DILLMAN APN

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE
CHICAGO IL
60637-1443
US

IV. Provider business mailing address

4328 S OAKENWALD AVE
CHICAGO IL
60653-3706
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-1000
  • Fax:
Mailing address:
  • Phone: 773-658-3187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209022656
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: