MEDICARE: DR. ROMAN F NIZIOLEK 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	036-067726	IL
2	207P00000X	Emergency Medicine Physician	036067726	IL

General Provider Information

NPI Number	:	1396729554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROMAN F NIZIOLEK M.D.

Provider Business Mailing Address
First Line	:	603 W NICHOLS RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-1321
Country	:	US
Telephone Number	:	224-234-7642
Fax Number	:

Provider Business Practice Location Address
First Line	:	5025 N PAULINA ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2772
Country	:	US
Telephone Number	:	773-271-9040
Fax Number	:	773-989-1516

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

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	08/11/2016

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