Healthcare Provider Details

I. General information

NPI: 1467645390
Provider Name (Legal Business Name): MICHAL PAWEL ZLOWODZKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7402 E RIVERSIDE BLVD
LOVES PARK IL
61111-5630
US

IV. Provider business mailing address

7402 E RIVERSIDE BLVD
LOVES PARK IL
61111-5630
US

V. Phone/Fax

Practice location:
  • Phone: 815-971-3920
  • Fax: 815-226-9672
Mailing address:
  • Phone: 815-971-3920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number01071909A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number2011-01628
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number036.141233
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: