Provider Demographics
NPI:1447376330
Name:WOJCIECH ORNOWSKI MD PC
Entity type:Organization
Organization Name:WOJCIECH ORNOWSKI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WOJCIECH
Authorized Official - Middle Name:
Authorized Official - Last Name:ORNOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-566-4134
Mailing Address - Street 1:16105 LA SALLE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-2064
Mailing Address - Country:US
Mailing Address - Phone:708-566-4134
Mailing Address - Fax:708-713-4143
Practice Address - Street 1:16105 LA SALLE ST
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-2064
Practice Address - Country:US
Practice Address - Phone:708-566-4134
Practice Address - Fax:708-713-4143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094416207R00000X
207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036094416Medicaid
ILG39818Medicare UPIN
IL208519Medicare ID - Type Unspecified