Healthcare Provider Details

I. General information

NPI: 1508282377
Provider Name (Legal Business Name): MACIEJ PADOWSKI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2014
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 GREENWOOD DR
DES PLAINES IL
60016
US

IV. Provider business mailing address

9500 GREENWOOD DR
DES PLAINES IL
60016-3946
US

V. Phone/Fax

Practice location:
  • Phone: 773-430-5600
  • Fax:
Mailing address:
  • Phone: 773-430-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number02006750A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036141518
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number67889-21
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: