Provider Demographics
NPI:1336105444
Name:SZATKOWSKI-PRITIKIN, MARY R (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:R
Last Name:SZATKOWSKI-PRITIKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 N WABASH AVE
Mailing Address - Street 2:STE 1810
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-2975
Mailing Address - Country:US
Mailing Address - Phone:312-332-4296
Mailing Address - Fax:312-419-6824
Practice Address - Street 1:111 N WABASH AVE
Practice Address - Street 2:STE 1810
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2975
Practice Address - Country:US
Practice Address - Phone:312-332-4296
Practice Address - Fax:312-419-6824
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036062384207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21609529OtherBCBS
IL670610Medicare ID - Type Unspecified
C41345Medicare UPIN