Provider Demographics
NPI:1528050598
Name:KROCZEK, BOHDAN J (MD)
Entity type:Individual
Prefix:DR
First Name:BOHDAN
Middle Name:J
Last Name:KROCZEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:150 N RIVER RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-1272
Mailing Address - Country:US
Mailing Address - Phone:847-299-1084
Mailing Address - Fax:847-299-8407
Practice Address - Street 1:150 N RIVER RD
Practice Address - Street 2:SUITE 230
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1272
Practice Address - Country:US
Practice Address - Phone:847-299-1084
Practice Address - Fax:847-299-8407
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL777180Medicare ID - Type Unspecified
ILC43318Medicare UPIN