Provider Demographics
NPI:1124060645
Name:PIOTROWSKI, MIROSLAW (MD)
Entity type:Individual
Prefix:DR
First Name:MIROSLAW
Middle Name:
Last Name:PIOTROWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5912 S ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2803
Mailing Address - Country:US
Mailing Address - Phone:773-735-5544
Mailing Address - Fax:
Practice Address - Street 1:5912 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2803
Practice Address - Country:US
Practice Address - Phone:773-735-5544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0361412576Medicaid
IL212130Medicare ID - Type Unspecified
IL0361412576Medicaid