Provider Demographics
NPI:1598847873
Name:KAKOL, CEZARY A (MD)
Entity Type:Individual
Prefix:
First Name:CEZARY
Middle Name:A
Last Name:KAKOL
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 1:6508 W ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638
Mailing Address - Country:US
Mailing Address - Phone:773-586-2220
Mailing Address - Fax:773-586-0086
Practice Address - Street 1:6508 W ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638
Practice Address - Country:US
Practice Address - Phone:773-586-2220
Practice Address - Fax:773-586-0086
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036095320207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095320Medicaid
G53041Medicare UPIN
534060Medicare ID - Type Unspecified