Provider Demographics
NPI:1659695351
Name:SUWARY, MAREK ROMUALD
Entity Type:Individual
Prefix:
First Name:MAREK
Middle Name:ROMUALD
Last Name:SUWARY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WINTERBERRY CT
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-2199
Mailing Address - Country:US
Mailing Address - Phone:630-440-6153
Mailing Address - Fax:630-213-0182
Practice Address - Street 1:2 WINTERBERRY CT
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-2199
Practice Address - Country:US
Practice Address - Phone:630-440-6153
Practice Address - Fax:630-213-0182
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010964225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist