Provider Demographics
NPI:1912224668
Name:NIEDOREZO, MACIEJ H (MFA)
Entity Type:Individual
Prefix:MR
First Name:MACIEJ
Middle Name:H
Last Name:NIEDOREZO
Suffix:
Gender:M
Credentials:MFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7659 GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-1836
Mailing Address - Country:US
Mailing Address - Phone:847-909-8684
Mailing Address - Fax:847-581-0212
Practice Address - Street 1:7659 GREENWOOD ST
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-1836
Practice Address - Country:US
Practice Address - Phone:847-909-8684
Practice Address - Fax:847-581-0212
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter