Healthcare Provider Details

I. General information

NPI: 1417112954
Provider Name (Legal Business Name): MAREK WALCZYK MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 HIGGINS RD 212
PARK RIDGE IL
60068-5743
US

IV. Provider business mailing address

1300 HIGGINS RD 212
PARK RIDGE IL
60068-5743
US

V. Phone/Fax

Practice location:
  • Phone: 847-823-5151
  • Fax:
Mailing address:
  • Phone: 847-823-5151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MAREK WALCZYK
Title or Position: OWNER
Credential: MD
Phone: 708-224-8840