Provider Demographics
NPI:1528203650
Name:JAMES R. PAWLIKOWSKI, LLC
Entity Type:Organization
Organization Name:JAMES R. PAWLIKOWSKI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:PAWLIKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-358-6378
Mailing Address - Street 1:11924 OAK CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-6728
Mailing Address - Country:US
Mailing Address - Phone:847-515-8131
Mailing Address - Fax:847-515-8142
Practice Address - Street 1:11924 OAK CREEK PKWY
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-6728
Practice Address - Country:US
Practice Address - Phone:847-515-8131
Practice Address - Fax:847-515-8142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036047711208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036047711Medicaid
ILC38769Medicare UPIN