Healthcare Provider Details

I. General information

NPI: 1366504649
Provider Name (Legal Business Name): WIESLAW J WOJNARSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3609 LAWSON RD
GLENVIEW IL
60026-1105
US

IV. Provider business mailing address

3609 LAWSON RD
GLENVIEW IL
60026-1105
US

V. Phone/Fax

Practice location:
  • Phone: 847-559-0596
  • Fax: 847-559-0596
Mailing address:
  • Phone: 847-559-0596
  • Fax: 847-559-0596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036072075
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: