Provider Demographics
NPI:1932181401
Name:LASTOWIECKI, PRZEMYSLAW (MD)
Entity Type:Individual
Prefix:MS
First Name:PRZEMYSLAW
Middle Name:
Last Name:LASTOWIECKI
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 1:1570 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-1101
Mailing Address - Country:US
Mailing Address - Phone:847-776-2257
Mailing Address - Fax:
Practice Address - Street 1:2500 W HIGGINS RD
Practice Address - Street 2:STE 640
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-2046
Practice Address - Country:US
Practice Address - Phone:847-895-0440
Practice Address - Fax:630-894-0492
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2019-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-086528207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
F35946Medicare UPIN