MEDICARE: DR. JAMES D DIETERICH 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	207XS0106X	Orthopaedic Hand Surgery Physician	036161687	IL

General Provider Information

NPI Number	:	1801327788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES D DIETERICH MD

Provider Business Mailing Address
First Line	:	3122 N ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3014
Country	:	US
Telephone Number	:	773-687-7000
Fax Number	:	773-687-7795

Provider Business Practice Location Address
First Line	:	3122 N ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3014
Country	:	US
Telephone Number	:	773-687-7000
Fax Number	:	773-687-7795

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

Provider Enumeration Date	:	03/23/2017
Last Update Date	:	06/08/2023

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