Individual
DR. WIESLAW J. PODLASEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2202 HARLEM ROAD, LOVES PARK, IL 61111-2754
(815) 877-4848
(815) 654-5342
Mailing address
2202 HARLEM ROAD, LOVES PARK, IL 61111-2754
(815) 877-4848
(815) 654-5342
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036-085145
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036085145
—
IL
01
—
P00911925
RAILROAD MEDICARE
IL
Enumeration date
03/12/2008
Last updated
09/14/2011
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