Provider Demographics
NPI:1467452573
Name:CIECHANOWSKI, ZBIGNIEW M (MD)
Entity Type:Individual
Prefix:DR
First Name:ZBIGNIEW
Middle Name:M
Last Name:CIECHANOWSKI
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 1:2020 DEAN ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1665
Mailing Address - Country:US
Mailing Address - Phone:630-513-0298
Mailing Address - Fax:630-578-6701
Practice Address - Street 1:2020 DEAN ST
Practice Address - Street 2:SUITE G
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1665
Practice Address - Country:US
Practice Address - Phone:630-513-0298
Practice Address - Fax:630-578-6701
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7316904081Medicaid
ILE94586Medicare UPIN
IL7316904081Medicaid