Provider Demographics
NPI:1497708333
Name:DRAZKIEWICZ, MACIEJ K (MD)
Entity Type:Individual
Prefix:MR
First Name:MACIEJ
Middle Name:K
Last Name:DRAZKIEWICZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2222 W DIVISION ST
Mailing Address - Street 2:STE 215
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-3094
Mailing Address - Country:US
Mailing Address - Phone:773-227-8807
Mailing Address - Fax:773-227-8907
Practice Address - Street 1:2222 W DIVISION ST
Practice Address - Street 2:STE 215
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-3094
Practice Address - Country:US
Practice Address - Phone:773-227-8807
Practice Address - Fax:773-227-8907
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2020-04-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036083034207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL376301OtherPTAN
IL036083034Medicaid
IL036083034Medicaid