MEDICARE: MARK EUGENE ZAJACKOWSKI MD

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	208D00000X	General Practice Physician	036-051907	IL

General Provider Information

NPI Number	:	1578857264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK EUGENE ZAJACKOWSKI MD

Provider Business Mailing Address
First Line	:	5445 N SHERIDAN RD
Second Line	:	#3102
City	:	CHICAGO
State	:	IL
Zip	:	60640-1957
Country	:	US
Telephone Number	:	773-271-0609
Fax Number	:

Provider Business Practice Location Address
First Line	:	5445 N SHERIDAN RD
Second Line	:	#3102
City	:	CHICAGO
State	:	IL
Zip	:	60640-1957
Country	:	US
Telephone Number	:	773-271-0609
Fax Number	:

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

Provider Enumeration Date	:	05/31/2011
Last Update Date	:	05/31/2011

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