Provider Demographics
NPI:1811594948
Name:WASILEWICZ, MACIEJ
Entity Type:Individual
Prefix:
First Name:MACIEJ
Middle Name:
Last Name:WASILEWICZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:947 WAUKEGAN RD APT 1A
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3050
Mailing Address - Country:US
Mailing Address - Phone:773-837-0123
Mailing Address - Fax:
Practice Address - Street 1:947 WAUKEGAN RD APT 1A
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-3050
Practice Address - Country:US
Practice Address - Phone:773-837-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.010963225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist