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General NPI Number Information
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NPI Number | 1699825133
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Entity Type | Organization
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Legal Business Name | W.J.SLODOWY M.D.INC.
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 02/03/2024
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Provider Practice Location Address
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Address Line | 3330 N HARLEM AVE
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City | CHICAGO
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State | IL
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Zip | 60634-3601
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Country | US
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Telephone | 773-889-7744
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Fax |
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Provider Business Mailing Address
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Address Line | 19 PORTSHIRE DR
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City | LINCOLNSHIRE
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State | IL
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Zip | 60069-3325
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Country | US
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Telephone | 847-317-1519
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WOJCIECH JAN SLODOWY
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Credential | M.D.
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Telephone | 773-889-7744
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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 | 036067404
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License Number State | IL
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