Healthcare Provider Details

I. General information

NPI: 1013243765
Provider Name (Legal Business Name): MARIAN IGNACY OLPINSKI M.D., PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2009
Last Update Date: 09/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 BIESTERFIELD RD STE 107
ELK GROVE VILLAGE IL
60007-3372
US

IV. Provider business mailing address

800 W BIESTERFIELD RD SUITE 107
ELK GROVE VILLAGE IL
60007
US

V. Phone/Fax

Practice location:
  • Phone: 847-593-9182
  • Fax: 847-593-3644
Mailing address:
  • Phone: 847-593-9182
  • Fax: 847-593-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036129163
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: