Basic Information
| Provider Information | |||||||||
| NPI: | 1295779585 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZAMIROWSKI | ||||||||
| FirstName: | THADDEUS | ||||||||
| MiddleName: | ANDREW | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1792 E OAKTON ST | ||||||||
| Address2: | |||||||||
| City: | DES PLAINES | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478274496 | ||||||||
| FaxNumber: | 8478271256 | ||||||||
| Practice Location | |||||||||
| Address1: | 1792 E OAKTON ST | ||||||||
| Address2: | |||||||||
| City: | DES PLAINES | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600182110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478274496 | ||||||||
| FaxNumber: | 8478271256 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 10/17/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036056115 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036056115 | 05 | IL | MEDICAID |