Provider Demographics
NPI:1093952756
Name:CENTER FOR INTERNAL MEDICINE INC.
Entity Type:Organization
Organization Name:CENTER FOR INTERNAL MEDICINE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIUSZ
Authorized Official - Middle Name:WOJCIECH
Authorized Official - Last Name:GADULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-425-0070
Mailing Address - Street 1:4609 W 103RD ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4718
Mailing Address - Country:US
Mailing Address - Phone:708-425-0070
Mailing Address - Fax:708-425-0304
Practice Address - Street 1:4609 W 103RD ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4718
Practice Address - Country:US
Practice Address - Phone:708-425-0070
Practice Address - Fax:708-425-0304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care