Provider Demographics
NPI:1649897596
Name:REMIASZ, ANDRZEJ
Entity type:Individual
Prefix:
First Name:ANDRZEJ
Middle Name:
Last Name:REMIASZ
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 1:8565 W DEMPSTER ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-1472
Mailing Address - Country:US
Mailing Address - Phone:847-299-7000
Mailing Address - Fax:847-299-7007
Practice Address - Street 1:8269 W GOLF RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1156
Practice Address - Country:US
Practice Address - Phone:847-299-7000
Practice Address - Fax:847-299-7007
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.025210225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070.025210OtherLICENSE