Healthcare Provider Details

I. General information

NPI: 1942473616
Provider Name (Legal Business Name): S A MASLANKA JR MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7447 W TALCOTT AVE
CHICAGO IL
60631-3745
US

IV. Provider business mailing address

7447 W TALCOTT AVE SUITE 148
CHICAGO IL
60631-3745
US

V. Phone/Fax

Practice location:
  • Phone: 773-631-9520
  • Fax: 773-631-9532
Mailing address:
  • Phone: 773-631-9520
  • Fax: 773-631-9532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036071835
License Number StateIL

VIII. Authorized Official

Name: DR. STANISLAW ALBERT MASLANKA JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 773-631-9520