=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184097792
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUKASZ RYCZEK
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2015
-----------------------------------------------------
Last Update Date | 11/04/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6950 W FOREST PRESERVE DR APT 213
-----------------------------------------------------
City | NORRIDGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60706-7196
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-225-0933
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6950 W FOREST PRESERVE DR APT 213
-----------------------------------------------------
City | NORRIDGE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60706-7196
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-225-0933
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2865M2000X
-----------------------------------------------------
Taxonomy Name | Military General Acute Care Hospital
-----------------------------------------------------
License Number | 041413948
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------