Healthcare Provider Details

I. General information

NPI: 1801827845
Provider Name (Legal Business Name): ANDRZEJ P. INDYK, M.D.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920 N CENTRAL AVE SUITE 2A
CHICAGO IL
60630-2338
US

IV. Provider business mailing address

4920 N CENTRAL AVE SUITE 2A
CHICAGO IL
60630-2338
US

V. Phone/Fax

Practice location:
  • Phone: 773-202-8034
  • Fax: 773-202-8147
Mailing address:
  • Phone: 773-202-8034
  • Fax: 773-202-8147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDRZEJ P INDYK
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 773-202-8034