Provider Demographics
NPI:1033368352
Name:DALE LIAUGMINAS, M.D. S.C.
Entity type:Organization
Organization Name:DALE LIAUGMINAS, M.D. S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:E
Authorized Official - Last Name:LIAUGMINAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-628-8450
Mailing Address - Street 1:303 W LAKE ST
Mailing Address - Street 2:#201
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-2586
Mailing Address - Country:US
Mailing Address - Phone:630-628-8450
Mailing Address - Fax:630-628-8091
Practice Address - Street 1:303 W LAKE ST
Practice Address - Street 2:#201
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-2586
Practice Address - Country:US
Practice Address - Phone:630-628-8450
Practice Address - Fax:630-628-8091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036057817174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036057817Medicaid
ILD15227Medicare UPIN
IL036057817Medicaid