Provider Demographics
NPI:1225206782
Name:ANDRZEJ GACEK MEDICAL , LLC
Entity Type:Organization
Organization Name:ANDRZEJ GACEK MEDICAL , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANDRZEJ
Authorized Official - Middle Name:JOZEF
Authorized Official - Last Name:GACEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-444-0553
Mailing Address - Street 1:5901 N MILWAUKEE AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5443
Mailing Address - Country:US
Mailing Address - Phone:773-631-1300
Mailing Address - Fax:773-631-3971
Practice Address - Street 1:5901 N MILWAUKEE AVE
Practice Address - Street 2:SUITE D
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5443
Practice Address - Country:US
Practice Address - Phone:773-631-1300
Practice Address - Fax:773-631-3971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-18
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036117533207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty