Provider Demographics
NPI:1700824604
Name:ZAJEWSKI, WITOLD M (MD)
Entity Type:Individual
Prefix:
First Name:WITOLD
Middle Name:M
Last Name:ZAJEWSKI
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 1:7900 N MILWAUKEE AVE STE 2-29
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-3237
Mailing Address - Country:US
Mailing Address - Phone:847-454-9181
Mailing Address - Fax:847-454-9184
Practice Address - Street 1:7900 N MILWAUKEE AVE STE 2-29
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-3237
Practice Address - Country:US
Practice Address - Phone:847-454-9181
Practice Address - Fax:847-454-9184
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.096849207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36096849Medicaid
IL36096849Medicaid
IL209764Medicare PIN