Basic Information
| Provider Information | |||||||||
| NPI: | 1275896300 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DODICK | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | ANTHONY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2650 RIDGE AVE. | ||||||||
| Address2: | DEPT. OF ANESTHESIOLOGY | ||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475702040 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2650 RIDGE AVE. | ||||||||
| Address2: | ANESTHESIOLOGY | ||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475702000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2012 | ||||||||
| LastUpdateDate: | 09/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LC0200X | 036146004 | IL | N | Allopathic & Osteopathic Physicians | Anesthesiology | Critical Care Medicine | 207L00000X | 036146004 | IL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.