Mateusz Baczek
Individual provider Active NPI Pharmacist · Beach Park, IL
NPI 1033744388 · NPPES record last updated Dec 1, 2020
Key facts
- NPI
- 1033744388
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 051.300528 (IL)
- Practice address
- 39161 N Sheridan Rd
Beach Park, IL 60099-3729 - Phone
- (847) 746-6230
- NPI assigned
- Mar 6, 2020
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051.300528 | IL | MD | Pharmacist |
| 19133-40 | WI | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wisconsin CVS Pharmacy LLC | Past |
Accepting new patients | |
| Wisconsin CVS Pharmacy LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 19133-40 | WI | |
| Pharmacist | 183500000X | 051.300528 | IL | Yes |
Addresses
Primary practice location
39161 N Sheridan Rd
Beach Park, IL 60099-3729
Mailing address
39161 N Sheridan Rd
Beach Park, IL 60099-3729
Phone (847) 746-6230
Other providers in Beach Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 1, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.