Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 03114143 | IL |
N | 111NI0900X | Internist | 03114143 | IL |
N | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 036-114143 | IL |
Y | 207RC0000X | Internist - Cardiovascular Disease | 036-114143 | IL |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | 036-114143 | IL |
NPI | 1740431410 |
---|---|
Provider Name | Mr. Grzegorz Marcin Pietrasik |
First Address | Chicago, IL 60611-2908 |
Second Address | Chicago, IL 60611-2908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2008 |
Last Update Date | 28/04/2021 |