Provider Demographics
NPI:1265021067
Name:INJURY CENTERS OF ILLINOIS
Entity Type:Organization
Organization Name:INJURY CENTERS OF ILLINOIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:DZIELAWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-969-4777
Mailing Address - Street 1:1604 SIBLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-2231
Mailing Address - Country:US
Mailing Address - Phone:708-360-3258
Mailing Address - Fax:
Practice Address - Street 1:1604 SIBLEY BLVD
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-2231
Practice Address - Country:US
Practice Address - Phone:708-360-3258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy