MEDICARE: W.J.SLODOWY M.D.INC.

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	036067404	IL

General Provider Information

NPI Number	:	1699825133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	W.J.SLODOWY M.D.INC.

Provider Business Mailing Address
First Line	:	19 PORTSHIRE DR
Second Line	:
City	:	LINCOLNSHIRE
State	:	IL
Zip	:	60069-3325
Country	:	US
Telephone Number	:	847-317-1519
Fax Number	:

Provider Business Practice Location Address
First Line	:	3330 N HARLEM AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-3601
Country	:	US
Telephone Number	:	773-889-7744
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WOJCIECH JAN SLODOWY
Credential	:	M.D.
Telephone Number	:	773-889-7744

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	02/03/2024

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