Provider Demographics
NPI:1184097792
Name:RYCZEK, LUKASZ
Entity type:Individual
Prefix:
First Name:LUKASZ
Middle Name:
Last Name:RYCZEK
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 1:6950 W FOREST PRESERVE DR APT 213
Mailing Address - Street 2:
Mailing Address - City:NORRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60706-7196
Mailing Address - Country:US
Mailing Address - Phone:773-225-0933
Mailing Address - Fax:
Practice Address - Street 1:6950 W FOREST PRESERVE DR APT 213
Practice Address - Street 2:
Practice Address - City:NORRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60706-7196
Practice Address - Country:US
Practice Address - Phone:773-225-0933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0414139482865M2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6950OtherVA EMPLOYMENT