Healthcare Provider Details

I. General information

NPI: 1255451019
Provider Name (Legal Business Name): MICHAL SZCZUPAK M.D.,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 11/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 BIESTERFIELD RD 408
ELK GROVE VILLAGE IL
60007-3361
US

IV. Provider business mailing address

800 BIESTERFIELD RD 408
ELK GROVE VILLAGE IL
60007-3361
US

V. Phone/Fax

Practice location:
  • Phone: 847-593-6600
  • Fax: 847-593-3544
Mailing address:
  • Phone: 847-593-6600
  • Fax: 847-593-3544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAL CEZARY SZCZUPAK
Title or Position: DOCTOR
Credential: M.D.
Phone: 847-593-6600