Provider Demographics
NPI:1124215223
Name:PAWEL K KWIECINSKI MD LTD
Entity type:Organization
Organization Name:PAWEL K KWIECINSKI MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAWEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:KWIECINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-283-1881
Mailing Address - Street 1:5356 W DIVERSEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-1513
Mailing Address - Country:US
Mailing Address - Phone:773-283-1881
Mailing Address - Fax:
Practice Address - Street 1:5356 W DIVERSEY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-1513
Practice Address - Country:US
Practice Address - Phone:773-283-1881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036069086207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1617311OtherBCBS
IL730521OtherMEDICARE GROUP
ILC42739Medicare UPIN
ILP07746Medicare PIN