Individual
LUKASZ J SIDOROWICZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3249 OAK PARK AVE, BERWYN, IL 60402-3429
(773) 502-4221
(773) 404-2086
Mailing address
PO BOX 56341, CHICAGO, IL 60656-0341
(708) 867-4949
(708) 867-4981
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
238.000043
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01637103
BLUE CROSS BLUE SHIELD OF IL
IL
Enumeration date
05/17/2007
Last updated
12/08/2009
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