Healthcare Provider Details

I. General information

NPI: 1821259003
Provider Name (Legal Business Name): MAREK J GRZESKOWIAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 CLAIRE CT
GLENVIEW IL
60025-7635
US

IV. Provider business mailing address

2050 CLAIRE CT
GLENVIEW IL
60025-7635
US

V. Phone/Fax

Practice location:
  • Phone: 847-556-1707
  • Fax: 847-556-1715
Mailing address:
  • Phone: 847-556-1707
  • Fax: 847-556-1715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number036126699
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: