MEDICARE: MR. MAREK WALCZYK M.D.

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	2084P0800X	Psychiatry Physician	36107779	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1632658	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1447243373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MAREK WALCZYK M.D.

Provider Business Mailing Address
First Line	:	5519 N. CUMBERLAND AVE.
Second Line	:	STE 1016
City	:	CHICAGO
State	:	IL
Zip	:	60656-0000
Country	:	US
Telephone Number	:	708-224-8840
Fax Number	:	773-594-7720

Provider Business Practice Location Address
First Line	:	5519 N. CUMBERLAND AVE.
Second Line	:	STE 1016
City	:	CHICAGO
State	:	IL
Zip	:	60656-0000
Country	:	US
Telephone Number	:	708-224-8840
Fax Number	:	773-594-7720

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	01/20/2009

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