Provider Demographics
NPI:1407847106
Name:KRAWCZYK, MITCHELL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:A
Last Name:KRAWCZYK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:17901 GOVERNORS HIGHWAY
Mailing Address - Street 2:STE 102
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430
Mailing Address - Country:US
Mailing Address - Phone:708-799-8880
Mailing Address - Fax:708-799-8991
Practice Address - Street 1:17901 GOVERNORS HIGHWAY
Practice Address - Street 2:STE 102
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430
Practice Address - Country:US
Practice Address - Phone:708-799-8880
Practice Address - Fax:708-799-8991
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D16062Medicare UPIN
IL753740Medicare ID - Type Unspecified