Healthcare Provider Details

I. General information

NPI: 1811150071
Provider Name (Legal Business Name): GRZEGORZ BLECHARZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1754 W GOLF RD
MOUNT PROSPECT IL
60056-4071
US

IV. Provider business mailing address

1754 W GOLF RD
MOUNT PROSPECT IL
60056-4071
US

V. Phone/Fax

Practice location:
  • Phone: 224-265-9010
  • Fax:
Mailing address:
  • Phone: 224-265-9010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number87639319
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036128361
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: