Individual provider Active NPI

Roman F Niziolek, M.D.

  • Internal Medicine Physician
  • Chicago, IL
National Provider Identifier
1396729554
Registry record updated Aug 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036-067726 Issued in IL
Practice address
5025 N Paulina St
Chicago, IL 60640-2772
Phone
(773) 271-9040
Fax
(773) 989-1516
NPI assigned
Dec 1, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 11, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036-067726 IL Primary
Emergency Medicine Physician 207P00000X 036067726 IL

Addresses

Primary practice location

5025 N Paulina St
Chicago, IL 60640-2772

Mailing address

603 W Nichols Rd
Arlington Heights, IL 60004-1321
Phone (224) 234-7642

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036-067726ILMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Thorek Radiology Group NFP Current Accepting new patients

Locations

2741 Paysphere Cir
Chicago, IL 60674

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470873600000",
    "number": "1396729554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 W NICHOLS RD",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600041321",
            "telephone_number": "224-234-7642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5025 N PAULINA ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606402772",
            "telephone_number": "773-271-9040",
            "fax_number": "773-989-1516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIZIOLEK",
        "first_name": "ROMAN",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-01",
        "last_updated": "2016-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036-067726",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036067726",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.