Provider Demographics
NPI:1801976030
Name:HENRY M BARANIEWSKI, M.D. LTD
Entity type:Organization
Organization Name:HENRY M BARANIEWSKI, M.D. LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARANIEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-635-6490
Mailing Address - Street 1:1333 INVERLIETH RD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1539
Mailing Address - Country:US
Mailing Address - Phone:847-635-6490
Mailing Address - Fax:847-234-5800
Practice Address - Street 1:3115 N HARLEM AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4684
Practice Address - Country:US
Practice Address - Phone:773-745-1700
Practice Address - Fax:847-234-5800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherFEDERAL TAX ID
IL997961Medicare ID - Type Unspecified