Provider Demographics
NPI:1538170303
Name:SZACHOWICZ, DONALD K (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:K
Last Name:SZACHOWICZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1536
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-7536
Mailing Address - Country:US
Mailing Address - Phone:847-967-8902
Mailing Address - Fax:847-803-0506
Practice Address - Street 1:150 N RIVER RD
Practice Address - Street 2:SUITE 320
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-1272
Practice Address - Country:US
Practice Address - Phone:847-803-0500
Practice Address - Fax:847-803-0506
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036085018207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036085018Medicaid
IL036085018Medicaid
ILF36738Medicare UPIN