Healthcare Provider Details

I. General information

NPI: 1538747076
Provider Name (Legal Business Name): KAMIL JAN WINNICKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 E WATERSIDE DR
CHICAGO IL
60601-0014
US

IV. Provider business mailing address

455 E WATERSIDE DR
CHICAGO IL
60601-0014
US

V. Phone/Fax

Practice location:
  • Phone: 224-302-6080
  • Fax: 312-586-7744
Mailing address:
  • Phone: 224-302-6080
  • Fax: 312-586-7744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number036.169418
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.078200
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: