Provider Demographics
NPI:1770673204
Name:WOJCIK, ROBERT STEVEN JR (MD,)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:STEVEN
Last Name:WOJCIK
Suffix:JR
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 1:1050 E NORRIS DR
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-1605
Mailing Address - Country:US
Mailing Address - Phone:815-433-3745
Mailing Address - Fax:815-433-6928
Practice Address - Street 1:920 WEST ST
Practice Address - Street 2:SUITE 118
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-2763
Practice Address - Country:US
Practice Address - Phone:815-223-6041
Practice Address - Fax:815-223-1463
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-097787208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036097787Medicaid
ILG80601Medicare UPIN