Provider Demographics
NPI:1972592061
Name:GRZESKOWIAK, WOJCIECH ZBIGNIEW (MD)
Entity type:Individual
Prefix:
First Name:WOJCIECH
Middle Name:ZBIGNIEW
Last Name:GRZESKOWIAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5370 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1250
Mailing Address - Country:US
Mailing Address - Phone:773-631-0377
Mailing Address - Fax:773-763-8756
Practice Address - Street 1:5370 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-1250
Practice Address - Country:US
Practice Address - Phone:773-631-0377
Practice Address - Fax:773-763-8756
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14DO936532OtherCUA
IL31604278OtherBC/BS
IL31604278OtherBC/BS
972670Medicare ID - Type Unspecified