Healthcare Provider Details

I. General information

NPI: 1225033871
Provider Name (Legal Business Name): THOMAS M KAZMIERCZAK JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 W US ROUTE 6
MORRIS IL
60450-8858
US

IV. Provider business mailing address

PO BOX 713260
CHICAGO IL
60677-1260
US

V. Phone/Fax

Practice location:
  • Phone: 815-942-0525
  • Fax: 815-942-3501
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036107879
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: