Provider Demographics
NPI:1962753210
Name:MILLENNIUM SURGICAL, INC
Entity type:Organization
Organization Name:MILLENNIUM SURGICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARTLOMIEJ
Authorized Official - Middle Name:LECH
Authorized Official - Last Name:NIERZWICKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DMD, PHD, FACS
Authorized Official - Phone:773-838-8855
Mailing Address - Street 1:5978 S ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2817
Mailing Address - Country:US
Mailing Address - Phone:773-838-8855
Mailing Address - Fax:773-796-3223
Practice Address - Street 1:5978 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2817
Practice Address - Country:US
Practice Address - Phone:773-838-8855
Practice Address - Fax:773-796-3223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021002267261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery