MEDICARE: DR. THOMAS B PAWLOWSKI M.D.

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	207R00000X	Internal Medicine Physician	036-061042	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	36-061042	OTHER	IL	LIC PHY AND SURGEON

General Provider Information

NPI Number	:	1093867921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS B PAWLOWSKI M.D.

Provider Business Mailing Address
First Line	:	2003 W FULTON ST STE 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-2365
Country	:	US
Telephone Number	:	773-292-4800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2003 W FULTON ST STE 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-2365
Country	:	US
Telephone Number	:	773-342-6200
Fax Number	:

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

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	06/02/2014

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