Provider Demographics
NPI:1538104500
Name:NIERZWICKI, BARTLOMIEJ LECH (MD, DMD, PHD)
Entity Type:Individual
Prefix:DR
First Name:BARTLOMIEJ
Middle Name:LECH
Last Name:NIERZWICKI
Suffix:
Gender:M
Credentials:MD, DMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5978 S ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2817
Mailing Address - Country:US
Mailing Address - Phone:773-838-8855
Mailing Address - Fax:773-796-3223
Practice Address - Street 1:5980 S. ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2817
Practice Address - Country:US
Practice Address - Phone:773-838-8855
Practice Address - Fax:773-796-3223
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210022671223S0112X
IL036126459204E00000X, 204E00000X
MO2009010655204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery