Healthcare Provider Details

I. General information

NPI: 1215033790
Provider Name (Legal Business Name): JERZY FELIKS ZADECKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 MAPLETON AVE
OAK PARK IL
60302-1404
US

IV. Provider business mailing address

930 MAPLETON AVE
OAK PARK IL
60302-1404
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-8387
  • Fax: 708-202-2108
Mailing address:
  • Phone: 708-202-8387
  • Fax: 708-202-2108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: