Provider Demographics
NPI:1215985155
Name:WINIECKI, ROBERT ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALAN
Last Name:WINIECKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1500 EISENHOWER LN
Mailing Address - Street 2:SUITE 700
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-2125
Mailing Address - Country:US
Mailing Address - Phone:630-964-1844
Mailing Address - Fax:630-964-1977
Practice Address - Street 1:1500 EISENHOWER LN
Practice Address - Street 2:SUITE 700
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-2125
Practice Address - Country:US
Practice Address - Phone:630-964-1844
Practice Address - Fax:630-964-1977
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C50849Medicare UPIN
782230Medicare ID - Type Unspecified