Provider Demographics
NPI:1447243373
Name:WALCZYK, MAREK (MD)
Entity Type:Individual
Prefix:MR
First Name:MAREK
Middle Name:
Last Name:WALCZYK
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 1:5519 N. CUMBERLAND AVE.
Mailing Address - Street 2:STE 1016
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-0000
Mailing Address - Country:US
Mailing Address - Phone:708-224-8840
Mailing Address - Fax:773-594-7720
Practice Address - Street 1:5519 N. CUMBERLAND AVE.
Practice Address - Street 2:STE 1016
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-0000
Practice Address - Country:US
Practice Address - Phone:708-224-8840
Practice Address - Fax:773-594-7720
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL361077792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL020363109Medicaid
IL1632658OtherBCBS
IL202328Medicare PIN
IL1632658OtherBCBS
H66423Medicare UPIN