Individual
DR. STANISLAW REWERSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
403 E 1ST ST, DIXON, IL 61021-3116
(815) 285-5629
Mailing address
403 E 1ST ST, DIXON, IL 61021-3116
(815) 285-5629
(815) 285-5634
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036-084832
IL
208M00000X
Hospitalist Physician
Primary
036084832
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036084832
—
IL
05
—
34604400
—
WI
Enumeration date
10/18/2005
Last updated
07/21/2022
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