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General NPI Number Information
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NPI Number | 1508075102
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Entity Type | Individual
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Provider Name | ROBERT STANISLAW BUDZIAKOWSKI M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 08/27/2009
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Provider Practice Location Address
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Address Line | 3115 N HARLEM AVE SUITE 201
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City | CHICAGO
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State | IL
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Zip | 60634-4684
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Country | US
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Telephone | 773-889-0355
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Fax |
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Provider Business Mailing Address
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Address Line | 720 N BROADWAY AVE
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City | PARK RIDGE
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State | IL
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Zip | 60068-2312
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036119835
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License Number State | IL
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