MEDICARE: MICHAL BARADZIEJ LPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	070017325	IL

General Provider Information

NPI Number	:	1083930861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAL BARADZIEJ LPT

Provider Business Mailing Address
First Line	:	6508 W ARCHER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-2423
Country	:	US
Telephone Number	:	773-313-3714
Fax Number	:

Provider Business Practice Location Address
First Line	:	6508 W ARCHER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-2423
Country	:	US
Telephone Number	:	773-313-3711
Fax Number	:	773-313-3714

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2010
Last Update Date	:	04/19/2010

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