Healthcare Provider Details

I. General information

NPI: 1790312643
Provider Name (Legal Business Name): ALEXANDER SCOTT KUCZMARSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 W HARRISON ST STE 400
CHICAGO IL
60612-4861
US

IV. Provider business mailing address

1 WESTBROOK CORPORATE CTR STE 240
WESTCHESTER IL
60154-5745
US

V. Phone/Fax

Practice location:
  • Phone: 312-432-2300
  • Fax:
Mailing address:
  • Phone: 708-236-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036.173751
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01095804A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number01095804A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number01095804A
License Number StateIN
# 5
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number036.173751
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: