Provider Demographics
NPI:1255451019
Name:MICHAL SZCZUPAK M.D.,LLC
Entity type:Organization
Organization Name:MICHAL SZCZUPAK M.D.,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAL
Authorized Official - Middle Name:CEZARY
Authorized Official - Last Name:SZCZUPAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-593-6600
Mailing Address - Street 1:800 BIESTERFIELD RD
Mailing Address - Street 2:408
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3361
Mailing Address - Country:US
Mailing Address - Phone:847-593-6600
Mailing Address - Fax:847-593-3544
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:408
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3361
Practice Address - Country:US
Practice Address - Phone:847-593-6600
Practice Address - Fax:847-593-3544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633659OtherBCBS
IL036106471Medicaid
IL01633659OtherBCBS