Provider Demographics
NPI:1801971171
Name:FOJTIK, JOSEPH E (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:E
Last Name:FOJTIK
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 1:3922 MERCY DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-3179
Mailing Address - Country:US
Mailing Address - Phone:815-344-4499
Mailing Address - Fax:815-344-4779
Practice Address - Street 1:3922 MERCY DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-3179
Practice Address - Country:US
Practice Address - Phone:815-344-4499
Practice Address - Fax:815-344-4779
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-073341207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1801971171Medicaid
WIFOJTIKOtherMERCYCARE INSURANCE
IL036073341 1Medicaid
WI1801971171OtherBCBSWI
IL795140L86956Medicare PIN
WI1801971171Medicaid
IL510420L82026Medicare PIN
WI1801971171OtherBCBSWI
WIFOJTIKOtherMERCYCARE INSURANCE