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General NPI Number Information
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NPI Number | 1992762645
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Entity Type | Individual
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Provider Name | TOMASZ CWIKLA M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 12/06/2012
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Provider Practice Location Address
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Address Line | 15614 S HARLEM AVE SUITE D
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City | ORLAND PARK
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State | IL
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Zip | 60462-4402
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Country | US
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Telephone | 708-444-0097
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Fax | 708-444-8252
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Provider Business Mailing Address
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Address Line | 15614 S HARLEM AVE SUITE D
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City | ORLAND PARK
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State | IL
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Zip | 60462-4402
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Country | US
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Telephone | 708-444-0097
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Fax | 708-444-8252
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036096768
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License Number State | IL
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