Provider Demographics
NPI:1508818055
Name:GAWRYSZ, MAREK (MD)
Entity Type:Individual
Prefix:
First Name:MAREK
Middle Name:
Last Name:GAWRYSZ
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 1:6318 W IRVING PARK ROAD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634
Mailing Address - Country:US
Mailing Address - Phone:773-286-1717
Mailing Address - Fax:773-286-0440
Practice Address - Street 1:6318 W IRVING PARK ROAD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634
Practice Address - Country:US
Practice Address - Phone:773-286-1717
Practice Address - Fax:773-286-0440
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336031676207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036067472Medicaid
IL036067472Medicaid
C44955Medicare UPIN
IL733540Medicare ID - Type Unspecified