Provider Demographics
NPI:1578762464
Name:ROGALSKI, MARIUSZ (MD)
Entity Type:Individual
Prefix:
First Name:MARIUSZ
Middle Name:
Last Name:ROGALSKI
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 1:16001 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403-0500
Mailing Address - Country:US
Mailing Address - Phone:630-418-5050
Mailing Address - Fax:
Practice Address - Street 1:16001 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403-0500
Practice Address - Country:US
Practice Address - Phone:630-418-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36108775207Q00000X
IL036108775207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine