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NPI Code Detail

MEDICARE: DALE ZIGULICH

MEDICARE: DALE ZIGULICH
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
1104100000XSocial Worker

General Provider Information

NPI Number : 1639736671
Entity Type Code : Individual
Provider Name (Legal Business Name) : DALE ZIGULICH
Provider Business Mailing Address
First Line : 108 PINE AVE
Second Line :
City : RIVERSIDE
State : IL
Zip : 60546-2105
Country : US
Telephone Number : 312-399-8428
Fax Number :
Provider Business Practice Location Address
First Line : 2755 N PINE GROVE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60614-6109
Country : US
Telephone Number : 312-399-8428
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2019
Last Update Date : 07/27/2023

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