Provider Demographics
NPI:1083905582
Name:OAK LAWN IMMEDIATE CARE LLC
Entity Type:Organization
Organization Name:OAK LAWN IMMEDIATE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERZY
Authorized Official - Middle Name:
Authorized Official - Last Name:SZYMANKSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-499-7661
Mailing Address - Street 1:4201 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2615
Mailing Address - Country:US
Mailing Address - Phone:708-499-7661
Mailing Address - Fax:773-754-3504
Practice Address - Street 1:4201 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2615
Practice Address - Country:US
Practice Address - Phone:773-754-3500
Practice Address - Fax:773-754-3504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-02
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty