Healthcare Provider Details

I. General information

NPI: 1124060645
Provider Name (Legal Business Name): MIROSLAW PIOTROWSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5912 S ARCHER AVE
CHICAGO IL
60638-2803
US

IV. Provider business mailing address

5912 S ARCHER AVE
CHICAGO IL
60638-2803
US

V. Phone/Fax

Practice location:
  • Phone: 773-735-5544
  • Fax:
Mailing address:
  • Phone: 773-735-5544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: