MEDICARE: MR. DEAN A DIRICO DPM

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	213E00000X	Podiatrist		IL

General Provider Information

NPI Number	:	1548330137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DEAN A DIRICO DPM

Provider Business Mailing Address
First Line	:	PO BOX 578246
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-8246
Country	:	US
Telephone Number	:	773-472-1882
Fax Number	:	773-472-1891

Provider Business Practice Location Address
First Line	:	2834 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-4202
Country	:	US
Telephone Number	:	773-472-1882
Fax Number	:	773-472-1891

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

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	07/08/2007

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