Individual
JAN WIACEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3204 N OAK PARK AVE, CHICAGO, IL 60634-4640
(773) 736-3131
Mailing address
3204 N OAK PARK AVE, CHICAGO, IL 60634-4640
(773) 736-3131
(773) 736-9416
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036088918
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036088918
—
IL
Enumeration date
05/27/2005
Last updated
10/23/2012
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