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General NPI Number Information
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NPI Number | 1225206782
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Entity Type | Organization
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Legal Business Name | ANDRZEJ GACEK MEDICAL , LLC
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Dates
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Enumeration Date | 02/18/2008
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Last Update Date | 03/02/2009
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Provider Practice Location Address
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Address Line | 5901 N MILWAUKEE AVE SUITE D
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City | CHICAGO
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State | IL
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Zip | 60646-5443
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Country | US
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Telephone | 773-631-1300
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Fax | 773-631-3971
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Provider Business Mailing Address
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Address Line | 5901 N MILWAUKEE AVE SUITE D
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City | CHICAGO
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State | IL
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Zip | 60646-5443
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Country | US
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Telephone | 773-631-1300
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Fax | 773-631-3971
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Authorized Official
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Title or Position | BILLING
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Name | MISS ANDRZEJ JOZEF GACEK
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Credential |
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Telephone | 847-444-0553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036117533
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License Number State | IL
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