Healthcare Provider Details

I. General information

NPI: 1972592061
Provider Name (Legal Business Name): WOJCIECH ZBIGNIEW GRZESKOWIAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5370 N MILWAUKEE AVE
CHICAGO IL
60630-1250
US

IV. Provider business mailing address

5370 N MILWAUKEE AVE
CHICAGO IL
60630-1250
US

V. Phone/Fax

Practice location:
  • Phone: 773-631-0377
  • Fax: 773-763-8756
Mailing address:
  • Phone: 773-631-0377
  • Fax: 773-763-8756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: