Provider Demographics
NPI:1164287017
Name:SULOCHA, GRZEGORZ
Entity type:Individual
Prefix:
First Name:GRZEGORZ
Middle Name:
Last Name:SULOCHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13917 W CANTIGNY LN
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-5933
Mailing Address - Country:US
Mailing Address - Phone:224-250-3035
Mailing Address - Fax:
Practice Address - Street 1:701 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-4037
Practice Address - Country:US
Practice Address - Phone:219-922-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-20
Last Update Date:2025-06-11
Deactivation Date:2024-10-29
Deactivation Code:
Reactivation Date:2025-05-22
Provider Licenses
StateLicense IDTaxonomies
IN26024898A207RH0003X
IL0512939181835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty