Provider Demographics
NPI:1447335658
Name:LIAUGMINAS, DALE E (MD)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:E
Last Name:LIAUGMINAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:199 S ADDISON RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WOOD DALE
Mailing Address - State:IL
Mailing Address - Zip Code:60191-1929
Mailing Address - Country:US
Mailing Address - Phone:630-628-8450
Mailing Address - Fax:630-860-5183
Practice Address - Street 1:199 S ADDISON RD
Practice Address - Street 2:SUITE 108
Practice Address - City:WOOD DALE
Practice Address - State:IL
Practice Address - Zip Code:60191-1929
Practice Address - Country:US
Practice Address - Phone:630-628-8450
Practice Address - Fax:630-860-5183
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036057817174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036057817Medicaid
712920Medicare PIN
ILD15227Medicare UPIN