Healthcare Provider Details

I. General information

NPI: 1033104021
Provider Name (Legal Business Name): WALTER J WOJCIK M.D,,PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 OAK PARK AVE SUITE 200
BERWYN IL
60402-3420
US

IV. Provider business mailing address

3340 OAK PARK AVE SUITE 200
BERWYN IL
60402-3420
US

V. Phone/Fax

Practice location:
  • Phone: 708-783-0222
  • Fax: 708-783-0223
Mailing address:
  • Phone: 708-783-0222
  • Fax: 708-783-0223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036-101766
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: