MEDICARE: DR. MATTHEW D. ZAWILENSKI MD SC

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	207Q00000X	Family Medicine Physician	036093984	IL

General Provider Information

NPI Number	:	1366851974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. MATTHEW D. ZAWILENSKI MD SC

Provider Business Mailing Address
First Line	:	800 BIESTERFIELD RD
Second Line	:	BROCK PAVILLION SUITE 2005
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-3361
Country	:	US
Telephone Number	:	847-550-0028
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 BIESTERFIELD RD
Second Line	:	SUITE 2005
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-3361
Country	:	US
Telephone Number	:	847-708-6014
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MATTHEW D ZAWILENSKI
Credential	:	MD
Telephone Number	:	847-550-0028

Provider Enumeration Date	:	08/07/2014
Last Update Date	:	10/29/2014

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