Healthcare Provider Details

I. General information

NPI: 1184097792
Provider Name (Legal Business Name): LUKASZ RYCZEK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2015
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6950 W FOREST PRESERVE DR APT 213
NORRIDGE IL
60706-7196
US

IV. Provider business mailing address

6950 W FOREST PRESERVE DR APT 213
NORRIDGE IL
60706-7196
US

V. Phone/Fax

Practice location:
  • Phone: 773-225-0933
  • Fax:
Mailing address:
  • Phone: 773-225-0933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number041413948
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: