MEDICARE: ROBERT E. PLACZEK D.D.S.,P.C.

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	1223G0001X	General Practice Dentistry	019020384	IL

General Provider Information

NPI Number	:	1184787848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT E. PLACZEK D.D.S.,P.C.

Provider Business Mailing Address
First Line	:	5650 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-3220
Country	:	US
Telephone Number	:	773-427-1310
Fax Number	:	773-427-1310

Provider Business Practice Location Address
First Line	:	5650 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-3220
Country	:	US
Telephone Number	:	773-427-1310
Fax Number	:	773-427-1310

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT E. PLACZEK
Credential	:	D.D.S.
Telephone Number	:	773-427-1310

Provider Enumeration Date	:	12/17/2006
Last Update Date	:	04/30/2012

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