Provider Demographics
NPI:1770533259
Name:WUJEK, DANIEL A (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:A
Last Name:WUJEK
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 1:1285 FRANCISCAN DR
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62056-1778
Mailing Address - Country:US
Mailing Address - Phone:217-324-6127
Mailing Address - Fax:327-324-5959
Practice Address - Street 1:1285 FRANCISCAN DR
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:IL
Practice Address - Zip Code:62056-1778
Practice Address - Country:US
Practice Address - Phone:217-324-6127
Practice Address - Fax:217-324-5959
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00201875OtherRAILROAD MEDICARE
ILK12565Medicare PIN
IL779330Medicare ID - Type UnspecifiedGROUP PROVIDER #
ILH81090Medicare UPIN
IL143822Medicare Oscar/Certification