Provider Demographics
NPI:1164287017
Name:SULOCHA, GRZEGORZ
Entity Type:Individual
Prefix:
First Name:GRZEGORZ
Middle Name:
Last Name:SULOCHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13917 W CANTIGNY LN
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-5933
Mailing Address - Country:US
Mailing Address - Phone:224-250-3035
Mailing Address - Fax:
Practice Address - Street 1:13917 W CANTIGNY LN
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-5933
Practice Address - Country:US
Practice Address - Phone:224-250-3035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0512939181835X0200X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No1835X0200XPharmacy Service ProvidersPharmacistOncology