Provider Demographics
NPI:1801492277
Name:MIKA, WOJCIECH JACEK (DPT)
Entity type:Individual
Prefix:
First Name:WOJCIECH
Middle Name:JACEK
Last Name:MIKA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 LE PARC CIR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-6914
Mailing Address - Country:US
Mailing Address - Phone:773-809-9425
Mailing Address - Fax:
Practice Address - Street 1:985 S BUFFALO GROVE RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-3702
Practice Address - Country:US
Practice Address - Phone:847-681-1161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist