Provider Demographics
NPI:1174788343
Name:PIETRZAK, CONSTANCE AGNES (MD)
Entity type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:AGNES
Last Name:PIETRZAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 W CORNELIA AVE
Mailing Address - Street 2:APT 2E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-2751
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17850 KEDZIE AVE STE 2100
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2056
Practice Address - Country:US
Practice Address - Phone:708-957-4011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-27
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125053383207R00000X
IL036126021207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine