MEDICARE: ANDRZEJ GACEK MEDICAL , LLC

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	207R00000X	Internal Medicine Physician	036117533	IL

General Provider Information

NPI Number	:	1225206782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDRZEJ GACEK MEDICAL , LLC

Provider Business Mailing Address
First Line	:	5901 N MILWAUKEE AVE
Second Line	:	SUITE D
City	:	CHICAGO
State	:	IL
Zip	:	60646-5443
Country	:	US
Telephone Number	:	773-631-1300
Fax Number	:	773-631-3971

Provider Business Practice Location Address
First Line	:	5901 N MILWAUKEE AVE
Second Line	:	SUITE D
City	:	CHICAGO
State	:	IL
Zip	:	60646-5443
Country	:	US
Telephone Number	:	773-631-1300
Fax Number	:	773-631-3971

Authorized Official
Title or Position	:	BILLING
Name	:	MISS ANDRZEJ JOZEF GACEK
Credential	:
Telephone Number	:	847-444-0553

Provider Enumeration Date	:	02/18/2008
Last Update Date	:	03/02/2009

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