Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 036083434 | IL |
N | 207QA0401X | Family Doctor - Addiction Medicine | 336-045720 | IL |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 036-083434 | IL |
NPI | 1760495113 |
---|---|
Provider Name | Stanley G Tomczyk |
First Address | Rolling Meadows, IL 60008-3257 |
Second Address | Rolling Meadows, IL 60008-3257 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 23/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A96623 | (02) | IL |