Healthcare Provider Details

I. General information

NPI: 1093952756
Provider Name (Legal Business Name): CENTER FOR INTERNAL MEDICINE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4609 W 103RD ST
OAK LAWN IL
60453-4718
US

IV. Provider business mailing address

4609 W 103RD ST
OAK LAWN IL
60453-4718
US

V. Phone/Fax

Practice location:
  • Phone: 708-425-0070
  • Fax: 708-425-0304
Mailing address:
  • Phone: 708-425-0070
  • Fax: 708-425-0304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. MARIUSZ WOJCIECH GADULA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 708-425-0070