Provider Demographics
NPI:1538145396
Name:KOLODZIEJCZYK, ROBERT A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:KOLODZIEJCZYK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1505 EASTLAND DR
Mailing Address - Street 2:LL1400
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3534
Mailing Address - Country:US
Mailing Address - Phone:309-663-4700
Mailing Address - Fax:309-665-0575
Practice Address - Street 1:1505 EASTLAND DR
Practice Address - Street 2:LL1400
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3534
Practice Address - Country:US
Practice Address - Phone:309-663-4700
Practice Address - Fax:309-665-0575
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036099571207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine