Provider Demographics
NPI:1497943229
Name:WITOLD M. ZAJEWSKI, M.D.,P.C.
Entity Type:Organization
Organization Name:WITOLD M. ZAJEWSKI, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER
Authorized Official - Prefix:
Authorized Official - First Name:WITOLD
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZAJEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-454-9181
Mailing Address - Street 1:PO BOX 7389
Mailing Address - Street 2:
Mailing Address - City:PROSPECT HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60070-7389
Mailing Address - Country:US
Mailing Address - Phone:847-454-9181
Mailing Address - Fax:847-454-9184
Practice Address - Street 1:609 N MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-2160
Practice Address - Country:US
Practice Address - Phone:847-454-9181
Practice Address - Fax:847-454-9184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK09395Medicare PIN
ILG63239Medicare UPIN
IL209764Medicare PIN