Provider Demographics
NPI:1417059114
Name:PIOTROWSKI, MARK JOHN (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:JOHN
Last Name:PIOTROWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1100 W CENTRAL RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005
Mailing Address - Country:US
Mailing Address - Phone:847-253-4040
Mailing Address - Fax:847-253-3028
Practice Address - Street 1:1100 W CENTRAL RD
Practice Address - Street 2:SUITE 205
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005
Practice Address - Country:US
Practice Address - Phone:847-253-4040
Practice Address - Fax:847-253-3028
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036108737207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01623492OtherBCBS
IL571890OtherMEDICARE GROUP NUMBER
IL036108737Medicaid
ILK00008OtherMEDICARE
IL036108737Medicaid
ILK00007Medicare ID - Type Unspecified