Provider Demographics
NPI:1346276110
Name:WOJEWODA, ANDRZEJ (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANDRZEJ
Middle Name:
Last Name:WOJEWODA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8044 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714
Mailing Address - Country:US
Mailing Address - Phone:847-609-1335
Mailing Address - Fax:
Practice Address - Street 1:7042 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-4423
Practice Address - Country:US
Practice Address - Phone:847-609-1335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1634768OtherBLUE CROSS/BLUE SHIELD NU
IL7720673OtherAETNA NUMBER
ILBW9049378OtherDEA NUMBER
IL7720673OtherAETNA NUMBER
V02239Medicare UPIN
IL1634768OtherBLUE CROSS/BLUE SHIELD NU