Provider Demographics
NPI:1598997249
Name:ROBERT BUDZIAKOWSKI, MD, S.C.
Entity Type:Organization
Organization Name:ROBERT BUDZIAKOWSKI, MD, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BUDZIAKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-889-0355
Mailing Address - Street 1:720 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-2312
Mailing Address - Country:US
Mailing Address - Phone:773-889-0355
Mailing Address - Fax:773-889-0803
Practice Address - Street 1:3115 N HARLEM AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4684
Practice Address - Country:US
Practice Address - Phone:773-889-0355
Practice Address - Fax:773-889-0803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036119835207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty