MEDICARE: MR. MAREK RUDNICKI 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	208600000X	Surgery Physician	036094616	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	:	1801810338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MAREK RUDNICKI M D

Provider Business Mailing Address
First Line	:	3000 N HALSTED ST
Second Line	:	SUITE 603
City	:	CHICAGO
State	:	IL
Zip	:	60657-5190
Country	:	US
Telephone Number	:	773-296-3838
Fax Number	:	773-327-1718

Provider Business Practice Location Address
First Line	:	3000 N HALSTED ST
Second Line	:	SUITE 603
City	:	CHICAGO
State	:	IL
Zip	:	60657-5190
Country	:	US
Telephone Number	:	773-296-3838
Fax Number	:	773-327-1718

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/26/2010

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