Provider Demographics
NPI:1679509046
Name:SZYMANSKI, JERZY (MD)
Entity Type:Individual
Prefix:DR
First Name:JERZY
Middle Name:
Last Name:SZYMANSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JERRY
Other - Middle Name:
Other - Last Name:SZYMANSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5257 S CICERO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-4915
Mailing Address - Country:US
Mailing Address - Phone:773-735-8038
Mailing Address - Fax:773-735-8297
Practice Address - Street 1:5257 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-4915
Practice Address - Country:US
Practice Address - Phone:773-735-8038
Practice Address - Fax:773-735-8297
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085357207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL352990Medicare PIN
ILF91365Medicare UPIN