Provider Demographics
NPI:1679665376
Name:ANDRZEJ WOJEWODA PODIATRY PC
Entity type:Organization
Organization Name:ANDRZEJ WOJEWODA PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRZEJ
Authorized Official - Middle Name:
Authorized Official - Last Name:WOJEWODA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-609-1335
Mailing Address - Street 1:8044 W CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2701
Mailing Address - Country:US
Mailing Address - Phone:847-609-1335
Mailing Address - Fax:
Practice Address - Street 1:7042 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-4423
Practice Address - Country:US
Practice Address - Phone:847-609-1335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7720673OtherAETNA
IL1634768OtherBCBS
IL1634768OtherBCBS
213036Medicare ID - Type UnspecifiedGROUP NUMBER