Provider Demographics
NPI:1487657318
Name:DMOWSKI, W. PAUL (MD, PHD)
Entity Type:Individual
Prefix:
First Name:W. PAUL
Middle Name:
Last Name:DMOWSKI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 W 22ND ST
Mailing Address - Street 2:STE 102
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-4643
Mailing Address - Country:US
Mailing Address - Phone:630-954-0054
Mailing Address - Fax:630-954-0064
Practice Address - Street 1:2425 W 22ND ST
Practice Address - Street 2:STE 102
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-4643
Practice Address - Country:US
Practice Address - Phone:630-954-0054
Practice Address - Fax:630-954-0064
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL022-15570OtherBC/BS
ILB90126Medicare UPIN
IL022-15570OtherBC/BS