Provider Demographics
NPI:1457430415
Name:ROZTOCZYNSKI, HENRYK (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:HENRYK
Middle Name:
Last Name:ROZTOCZYNSKI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6157 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4004
Mailing Address - Country:US
Mailing Address - Phone:773-745-8434
Mailing Address - Fax:773-745-3443
Practice Address - Street 1:6157 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4004
Practice Address - Country:US
Practice Address - Phone:773-745-8434
Practice Address - Fax:773-745-3443
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036058369207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31600059OtherBCBS
IL036058369Medicaid
IL31600059OtherBCBS
IL646150Medicare ID - Type Unspecified