Provider Demographics
NPI:1699825133
Name:W.J.SLODOWY M.D.INC.
Entity Type:Organization
Organization Name:W.J.SLODOWY M.D.INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WOJCIECH
Authorized Official - Middle Name:JAN
Authorized Official - Last Name:SLODOWY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-889-7744
Mailing Address - Street 1:19 PORTSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069-3325
Mailing Address - Country:US
Mailing Address - Phone:847-317-1519
Mailing Address - Fax:
Practice Address - Street 1:3330 N HARLEM AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-3601
Practice Address - Country:US
Practice Address - Phone:773-889-7744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2024-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036067404207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK15089Medicare UPIN
IL211079Medicare ID - Type Unspecified