MEDICARE: WOJCIECH ZBIGNIEW GRZESKOWIAK 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	207Q00000X	Family Medicine Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14DO936532	OTHER	IL	CUA
2	31604278	OTHER	IL	BC/BS

General Provider Information

NPI Number	:	1972592061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WOJCIECH ZBIGNIEW GRZESKOWIAK MD

Provider Business Mailing Address
First Line	:	5370 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-1250
Country	:	US
Telephone Number	:	773-631-0377
Fax Number	:	773-763-8756

Provider Business Practice Location Address
First Line	:	5370 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-1250
Country	:	US
Telephone Number	:	773-631-0377
Fax Number	:	773-763-8756

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	07/08/2007

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