Healthcare Provider Details

I. General information

NPI: 1346276110
Provider Name (Legal Business Name): ANDRZEJ WOJEWODA D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7042 N MILWAUKEE AVE
NILES IL
60714-4423
US

IV. Provider business mailing address

8044 CEDAR LN
NILES IL
60714
US

V. Phone/Fax

Practice location:
  • Phone: 847-609-1335
  • Fax:
Mailing address:
  • Phone: 847-609-1335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: