Healthcare Provider Details

I. General information

NPI: 1689137184
Provider Name (Legal Business Name): BARTLOMIEJ LUKASZ RADZIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 10/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 S. WOOD ST. SUITE 130 CSN
CHICAGO IL
60612
US

IV. Provider business mailing address

4132 N OLCOTT AVE
NORRIDGE IL
60706-1111
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-7312
  • Fax:
Mailing address:
  • Phone: 708-408-3574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number125074712
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: