1588945695 NPI number — UNIVERSITY OF ILLINOIS CHICAGO/ACMC

Table of content: DR. STEVEN ROBERT WANZEK MD (NPI 1477535771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588945695 NPI number — UNIVERSITY OF ILLINOIS CHICAGO/ACMC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF ILLINOIS CHICAGO/ACMC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588945695
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9515 S KILDARE AVE
Provider Second Line Business Mailing Address:
APT 302
Provider Business Mailing Address City Name:
OAK LAWN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60453-6155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-571-9124
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4440 W 95TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK LAWN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60453-2600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-571-9124
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HUSSAIN
Authorized Official First Name:
SYEDA
Authorized Official Middle Name:
FATIMA
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
646-571-9124

Provider Taxonomy Codes

  • Taxonomy code: 282E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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