MEDICARE: DR. STANISLAW BRYJAK 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	207Q00000X	Family Medicine Physician	036.112233	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	:	1932159126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STANISLAW BRYJAK M.D.

Provider Business Mailing Address
First Line	:	2740 W FOSTER AVE
Second Line	:	LL7
City	:	CHICAGO
State	:	IL
Zip	:	60625-3500
Country	:	US
Telephone Number	:	773-878-8200
Fax Number	:	773-293-4197

Provider Business Practice Location Address
First Line	:	5215 N CALIFORNIA AVE
Second Line	:	SUITE 603
City	:	CHICAGO
State	:	IL
Zip	:	60625-7014
Country	:	US
Telephone Number	:	773-275-1020
Fax Number	:

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

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	10/30/2020

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