Provider Demographics
NPI:1467598235
Name:MILEJCZYK, MARIUSZ (MD)
Entity type:Individual
Prefix:MR
First Name:MARIUSZ
Middle Name:
Last Name:MILEJCZYK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 TOWER CRT 255
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031
Mailing Address - Country:US
Mailing Address - Phone:847-623-8818
Mailing Address - Fax:847-625-8059
Practice Address - Street 1:1880 W WINCHESTER RD STE 106
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5321
Practice Address - Country:US
Practice Address - Phone:847-367-4277
Practice Address - Fax:847-810-0287
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036093940207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG89151Medicare UPIN