Provider Demographics
NPI:1679846786
Name:PAWLOWSKI, PIOTR (CSA)
Entity Type:Individual
Prefix:
First Name:PIOTR
Middle Name:
Last Name:PAWLOWSKI
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 ARMITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60164-1705
Mailing Address - Country:US
Mailing Address - Phone:847-951-3724
Mailing Address - Fax:
Practice Address - Street 1:256 ARMITAGE AVE
Practice Address - Street 2:
Practice Address - City:NORTHLAKE
Practice Address - State:IL
Practice Address - Zip Code:60164-1705
Practice Address - Country:US
Practice Address - Phone:847-951-3724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000133246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist