1366564189 NPI number — MR. WARREN EDWARD SZKUDLAREK SR. NAPRAPTH DN

Table of content: MAYA MERRYAM MOURAD (NPI 1053774166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366564189 NPI number — MR. WARREN EDWARD SZKUDLAREK SR. NAPRAPTH DN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SZKUDLAREK
Provider First Name:
WARREN
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
NAPRAPTH DN
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SZKUDLAREK
Provider Other First Name:
WARREN
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1366564189
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2937 LOGAN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60647-1760
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-490-0130
Provider Business Mailing Address Fax Number:
773-384-6598

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2937 LOGAN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60647-1760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-490-0130
Provider Business Practice Location Address Fax Number:
773-384-6598
Provider Enumeration Date:
04/04/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 172P00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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