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General NPI Number Information
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NPI Number | 1750465084
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Entity Type | Individual
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Provider Name | WAYNE RICHARD CICHOWICZ D.N., L.D.N.
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Gender | Male
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 3602 S 61ST AVE
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City | CICERO
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State | IL
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Zip | 60804-4146
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Country | US
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Telephone | 708-656-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 3602 S 61ST AVE
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City | CICERO
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State | IL
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Zip | 60804-4146
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Country | US
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Telephone | 708-656-7000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | IL
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