Provider Demographics
NPI:1457328874
Name:MUZYKANSKY, EUGENE A (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:A
Last Name:MUZYKANSKY
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 1:5851 W 95TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2415
Mailing Address - Country:US
Mailing Address - Phone:708-636-1601
Mailing Address - Fax:708-636-1825
Practice Address - Street 1:5851 W 95TH ST STE 100
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2415
Practice Address - Country:US
Practice Address - Phone:708-636-1601
Practice Address - Fax:708-636-1825
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098613207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036098613Medicaid
IL638020Medicare ID - Type Unspecified