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General NPI Number Information
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NPI Number | 1124433248
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Entity Type | Organization
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Legal Business Name | FOUNDATION FOR MEDICAL DEVELOPMENT IN CENTRAL EUROPE INC
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Dates
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Enumeration Date | 06/26/2014
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Last Update Date | 11/07/2014
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Provider Practice Location Address
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Address Line | 1927 SHERMAN AVE APT 3N
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City | EVANSTON
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State | IL
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Zip | 60201-3229
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Country | US
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Telephone | 847-328-7316
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Fax | 847-425-5155
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Provider Business Mailing Address
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Address Line | 1927 SHERMAN AVE APT 3N
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City | EVANSTON
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State | IL
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Zip | 60201-3229
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Country | US
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Telephone | 847-328-7316
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Fax | 847-425-5155
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANDREW M BARTKOWSKI
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Credential | R.P.T.,M.SC., M.B.A.
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Telephone | 847-328-7316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 070.006767
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License Number State | IL
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