Provider Demographics
NPI:1730260324
Name:GOLEC, JANUSZ EDWARD (MD)
Entity type:Individual
Prefix:MR
First Name:JANUSZ
Middle Name:EDWARD
Last Name:GOLEC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5344 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-1250
Mailing Address - Country:US
Mailing Address - Phone:773-763-7108
Mailing Address - Fax:773-763-4901
Practice Address - Street 1:5344 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-1250
Practice Address - Country:US
Practice Address - Phone:773-763-7108
Practice Address - Fax:773-763-4901
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036066249207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILAG2048088OtherDEA
ILC45756Medicare PIN