MEDICARE: RICHARD GERARD CZUMA

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	207RS0012X	Sleep Medicine (Internal Medicine) Physician	036166840	IL
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1295232064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD GERARD CZUMA

Provider Business Mailing Address
First Line	:	12251 S 80TH AVE STE 1780
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1290
Country	:	US
Telephone Number	:	708-923-3420
Fax Number	:	708-923-3399

Provider Business Practice Location Address
First Line	:	12251 S 80TH AVE STE 1780
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1290
Country	:	US
Telephone Number	:	708-923-3420
Fax Number	:	708-923-3399

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

Provider Enumeration Date	:	04/09/2018
Last Update Date	:	12/18/2025

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