Provider Demographics
NPI:1275639585
Name:WITEK, BOZENA (MD)
Entity Type:Individual
Prefix:DR
First Name:BOZENA
Middle Name:
Last Name:WITEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7447 W TALCOTT AVE
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3745
Mailing Address - Country:US
Mailing Address - Phone:773-774-0042
Mailing Address - Fax:773-774-2008
Practice Address - Street 1:7447 W TALCOTT AVE
Practice Address - Street 2:SUITE ONE
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3745
Practice Address - Country:US
Practice Address - Phone:773-774-0042
Practice Address - Fax:773-774-2008
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036076914207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF35274Medicare UPIN
ILL60119Medicare PIN