MEDICARE: JOHN J DYMOWSKI MD

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	207P00000X	Emergency Medicine Physician	036-069178	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	:	1053312280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN J DYMOWSKI MD

Provider Business Mailing Address
First Line	:	1860 PAYSPHERE CIR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-0018
Country	:	US
Telephone Number	:	630-469-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1206 E 9TH ST
Second Line	:
City	:	LOCKPORT
State	:	IL
Zip	:	60441-2404
Country	:	US
Telephone Number	:	888-693-6437
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	08/18/2021

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Directions to “ JOHN J DYMOWSKI MD” Practice Location

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