Healthcare Provider Details

I. General information

NPI: 1033309653
Provider Name (Legal Business Name): ROBERT PIOTR PIOTROWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 09/04/2022
Certification Date: 09/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3936 N MILWAUKEE AVE
CHICAGO IL
60641
US

IV. Provider business mailing address

3936 N MILWAUKEE AVE
CHICAGO IL
60641
US

V. Phone/Fax

Practice location:
  • Phone: 773-736-6125
  • Fax: 773-736-9629
Mailing address:
  • Phone: 773-736-6125
  • Fax: 773-736-9626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036122174
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: