Provider Demographics
NPI:1508887183
Name:LOJEWSKI, BLAZEJ (MD)
Entity Type:Individual
Prefix:
First Name:BLAZEJ
Middle Name:
Last Name:LOJEWSKI
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 1:60 S DEE RD APT D
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-3731
Mailing Address - Country:US
Mailing Address - Phone:847-738-8774
Mailing Address - Fax:
Practice Address - Street 1:60 S DEE RD APT D
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3731
Practice Address - Country:US
Practice Address - Phone:847-738-8774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089496202K00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G82159Medicare UPIN
492940Medicare ID - Type Unspecified