MEDICARE: DR. MARIUSZ W GADULA MD

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	036088145	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548292832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIUSZ W GADULA MD

Provider Business Mailing Address
First Line	:	4609 W 103RD ST
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-4718
Country	:	US
Telephone Number	:	708-425-0070
Fax Number	:	708-425-0304

Provider Business Practice Location Address
First Line	:	4609 W 103RD ST
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-4718
Country	:	US
Telephone Number	:	708-425-0070
Fax Number	:	708-425-0304

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	12/06/2021

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