MEDICARE: ROBERT BUDZIAKOWSKI, MD, S.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	207Q00000X	Family Medicine Physician	036119835	IL

General Provider Information

NPI Number	:	1598997249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT BUDZIAKOWSKI, MD, S.C.

Provider Business Mailing Address
First Line	:	720 N BROADWAY AVE
Second Line	:
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-2312
Country	:	US
Telephone Number	:	773-889-0355
Fax Number	:	773-889-0803

Provider Business Practice Location Address
First Line	:	3115 N HARLEM AVE
Second Line	:	SUITE 201
City	:	CHICAGO
State	:	IL
Zip	:	60634-4684
Country	:	US
Telephone Number	:	773-889-0355
Fax Number	:	773-889-0803

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT BUDZIAKOWSKI
Credential	:	MD
Telephone Number	:	773-889-0355

Provider Enumeration Date	:	08/13/2009
Last Update Date	:	08/13/2009

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