Healthcare Provider Details

I. General information

NPI: 1073250718
Provider Name (Legal Business Name): MICHAL BUDZIAKOWSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2022
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8170 33RD AVE S
BLOOMINGTON MN
55425-4516
US

IV. Provider business mailing address

350 CRABTREE LN
GLENVIEW IL
60025-5113
US

V. Phone/Fax

Practice location:
  • Phone: 952-541-2902
  • Fax:
Mailing address:
  • Phone: 847-224-9368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number81122
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: