Provider Demographics
NPI:1427153618
Name:WARAKOMSKI, ROMUALD C (DO)
Entity type:Individual
Prefix:
First Name:ROMUALD
Middle Name:C
Last Name:WARAKOMSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:71 W 156TH ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-4260
Mailing Address - Country:US
Mailing Address - Phone:708-331-2200
Mailing Address - Fax:708-331-8015
Practice Address - Street 1:19550 GOVERNORS HWY
Practice Address - Street 2:SUITE 2900
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2125
Practice Address - Country:US
Practice Address - Phone:708-331-2200
Practice Address - Fax:708-331-8015
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036076749207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036076749Medicaid
110163533/CA4448OtherRAILROAD PALMETTO GBA
ILL66475Medicare ID - Type Unspecified
E99275Medicare UPIN