Healthcare Provider Details

I. General information

NPI: 1750465084
Provider Name (Legal Business Name): WAYNE RICHARD CICHOWICZ D.N., L.D.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3602 S 61ST AVE
CICERO IL
60804-4146
US

IV. Provider business mailing address

3602 S 61ST AVE
CICERO IL
60804-4146
US

V. Phone/Fax

Practice location:
  • Phone: 708-656-7000
  • Fax:
Mailing address:
  • Phone: 708-656-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: