Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 021002267 | IL |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 036126459 | IL |
N | 204E00000X | Oral & Maxillofacial Surgeon | 2009010655 | MO |
N | 204E00000X | Oral & Maxillofacial Surgeon | A99151 | CA |
NPI | 1538104500 |
---|---|
Provider Name | Dr. Bartlomiej Lech Nierzwicki |
First Address | Chicago, IL 60638-2817 |
Second Address | Chicago, IL 60638-2817 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 13/09/2012 |