Evan B Mazurkiewicz, DO

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

125.081614 Issued in IL

Practice address

20201 Crawford Ave
Olympia Fields, IL 60461-1010

Phone

(708) 855-8007

Fax

(708) 503-3241

NPI assigned

Apr 3, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1680480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683244800000",
    "number": "1942905435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1640 N NORTH PARK AVE APT 3",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606148085",
            "telephone_number": "219-728-9024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20201 CRAWFORD AVE",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611010",
            "telephone_number": "708-855-8007",
            "fax_number": "708-503-3241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZURKIEWICZ",
        "first_name": "EVAN",
        "middle_name": "B",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-04-03",
        "last_updated": "2023-05-05",
        "certification_date": "2023-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "125.081614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amani Masoud
• Jill Lyn Matson, LPC
• Nathan Michael Matwick, D.O.
• Pearl Mawst
• Hayley A Mayers, PTA
• Howard K MC Nair, M.D.
• Michele McCallum
• Shalese McClain
• Daniel P McCormick, M.D.
• James V McGarry, M.D.

• Surgery Physician in Olympia Fields, IL
• Providers in Olympia Fields, IL by specialty
• Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.