Provider Demographics
NPI:1053387274
Name:DICKLER, ADAM (MD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:DICKLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 ENTERPRISE DR STE 4506
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5803
Mailing Address - Country:US
Mailing Address - Phone:708-492-0502
Mailing Address - Fax:708-492-0565
Practice Address - Street 1:160 E ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5426
Practice Address - Country:US
Practice Address - Phone:312-595-1444
Practice Address - Fax:312-477-2391
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1075282085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036107528Medicaid
ILK41380Medicare PIN
ILK18172Medicare PIN
ILK41379Medicare PIN
IL212210042Medicare PIN
IL036107528Medicaid
ILF400112813Medicare PIN