MEDICARE: DALE LIAUGMINAS, M.D. S.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	036057817	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033368352
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALE LIAUGMINAS, M.D. S.C.

Provider Business Mailing Address
First Line	:	303 W LAKE ST
Second Line	:	#201
City	:	ADDISON
State	:	IL
Zip	:	60101-2586
Country	:	US
Telephone Number	:	630-628-8450
Fax Number	:	630-628-8091

Provider Business Practice Location Address
First Line	:	303 W LAKE ST
Second Line	:	#201
City	:	ADDISON
State	:	IL
Zip	:	60101-2586
Country	:	US
Telephone Number	:	630-628-8450
Fax Number	:	630-628-8091

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. DALE E. LIAUGMINAS
Credential	:	M.D.
Telephone Number	:	630-628-8450

Provider Enumeration Date	:	09/10/2008
Last Update Date	:	09/10/2008

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