Provider Demographics
NPI:1801827845
Name:ANDRZEJ P. INDYK, M.D.S.C.
Entity Type:Organization
Organization Name:ANDRZEJ P. INDYK, M.D.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRZEJ
Authorized Official - Middle Name:P
Authorized Official - Last Name:INDYK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-202-8034
Mailing Address - Street 1:4920 N CENTRAL AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2338
Mailing Address - Country:US
Mailing Address - Phone:773-202-8034
Mailing Address - Fax:773-202-8147
Practice Address - Street 1:4920 N CENTRAL AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2338
Practice Address - Country:US
Practice Address - Phone:773-202-8034
Practice Address - Fax:773-202-8147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX ID NUMBER
ILK28388Medicare PIN
IL=========OtherTAX ID NUMBER
ILF29144Medicare UPIN