Provider Demographics
NPI:1033838560
Name:BIZUB, ADAM MAREK (RN)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:MAREK
Last Name:BIZUB
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8107 W 89TH ST
Mailing Address - Street 2:
Mailing Address - City:HICKORY HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60457-1454
Mailing Address - Country:US
Mailing Address - Phone:570-801-2179
Mailing Address - Fax:
Practice Address - Street 1:8107 W 89TH ST
Practice Address - Street 2:
Practice Address - City:HICKORY HILLS
Practice Address - State:IL
Practice Address - Zip Code:60457-1454
Practice Address - Country:US
Practice Address - Phone:570-801-2179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041463804163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse