Provider Demographics
NPI:1679606560
Name:PUSZKARSKI, SLAWOMIR JAN (MD)
Entity Type:Individual
Prefix:
First Name:SLAWOMIR
Middle Name:JAN
Last Name:PUSZKARSKI
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 1:5420 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1225
Mailing Address - Country:US
Mailing Address - Phone:773-594-9944
Mailing Address - Fax:773-594-9980
Practice Address - Street 1:5420 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-1225
Practice Address - Country:US
Practice Address - Phone:773-594-9944
Practice Address - Fax:735-949-9807
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0916842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G21950Medicare UPIN