Provider Demographics
NPI:1427164367
Name:DZWINYK, JAROSLAW B (MD)
Entity type:Individual
Prefix:DR
First Name:JAROSLAW
Middle Name:B
Last Name:DZWINYK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2740 W FOSTER AVE
Mailing Address - Street 2:LL7
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3500
Mailing Address - Country:US
Mailing Address - Phone:773-878-8200
Mailing Address - Fax:773-293-4197
Practice Address - Street 1:5215 N CALIFORNIA AVE
Practice Address - Street 2:STE. 804
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-7014
Practice Address - Country:US
Practice Address - Phone:773-878-8200
Practice Address - Fax:847-520-9190
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036068424207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
40612079OtherPTAN
IL036068424Medicaid
IL1619562OtherBC/BS
IL200017095OtherMEDICARE RAILROAD
IL0721670001Medicare NSC
ILL29260Medicare PIN