Provider Demographics
NPI:1366504649
Name:WOJNARSKI, WIESLAW J (MD)
Entity Type:Individual
Prefix:
First Name:WIESLAW
Middle Name:J
Last Name:WOJNARSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3609 LAWSON RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1105
Mailing Address - Country:US
Mailing Address - Phone:847-559-0596
Mailing Address - Fax:847-559-0596
Practice Address - Street 1:3609 LAWSON RD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1105
Practice Address - Country:US
Practice Address - Phone:847-559-0596
Practice Address - Fax:847-559-0596
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036072075207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31622517OtherBLUE CROSS OF ILLINOIS
IL36072075Medicaid
ILC48718Medicare UPIN
IL0138420001Medicare NSC
IL31622517OtherBLUE CROSS OF ILLINOIS