Healthcare Provider Details

I. General information

NPI: 1114905171
Provider Name (Legal Business Name): TOMASZ J KUZNIAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE SUITE 5301
EVANSTON IL
60201-1718
US

IV. Provider business mailing address

1008 CENTRAL AVE
WILMETTE IL
60091-2610
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-2714
  • Fax: 847-733-5109
Mailing address:
  • Phone: 847-630-2856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number47702
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: