Provider Demographics
NPI:1770636201
Name:CZARNKOWSKI, JAROSLAW P (MD)
Entity Type:Individual
Prefix:DR
First Name:JAROSLAW
Middle Name:P
Last Name:CZARNKOWSKI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:912 S WOOD ST
Mailing Address - Street 2:MC 913
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4300
Mailing Address - Country:US
Mailing Address - Phone:312-996-2200
Mailing Address - Fax:312-996-3614
Practice Address - Street 1:912 S WOOD ST
Practice Address - Street 2:MC 913
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4300
Practice Address - Country:US
Practice Address - Phone:312-996-2200
Practice Address - Fax:312-996-3614
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2010-04-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL361174542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36117454OtherPHYSICIAN LICENSE