Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 036-101766 | IL |
NPI | 1033104021 |
---|---|
Provider Name | Dr. Walter J Wojcik |
First Address | Berwyn, IL 60402-3420 |
Second Address | Berwyn, IL 60402-3420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2005 |
Last Update Date | 14/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036101766 | (05) | IL |
130024568 | RR MEDICARE (01) | IL |
H20232 | (02) | IL |