Provider Demographics
NPI:1336363431
Name:DRS SZEWCZYK & NEKOLA LLC
Entity Type:Organization
Organization Name:DRS SZEWCZYK & NEKOLA LLC
Other - Org Name:SZEWCZYK SZEWCZYK NEKOLA MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SZEWCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-235-2400
Mailing Address - Street 1:4900 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-4725
Mailing Address - Country:US
Mailing Address - Phone:618-235-2400
Mailing Address - Fax:618-235-0900
Practice Address - Street 1:4900 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-4725
Practice Address - Country:US
Practice Address - Phone:618-235-2400
Practice Address - Fax:618-235-0900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036092365207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00762OtherPIN
08215191OtherBCBS
ILG55037OtherUPIN NUMBER
L59429OtherPIN
CB0524OtherRR MEDICARE
IL036070355Medicaid
IL036031388Medicaid
IL036092365Medicaid
P00761OtherPIN
08215191OtherBCBS
CB0524OtherRR MEDICARE
289730Medicare ID - Type Unspecified