Basic Information
| Provider Information | |||||||||
| NPI: | 1740309418 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAMIEN | ||||||||
| FirstName: | PRZEMYSLAW | ||||||||
| MiddleName: | MATEUSZ | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9650 GROSS POINT RD STE 2900 | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600761214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478667846 | ||||||||
| FaxNumber: | 8668545815 | ||||||||
| Practice Location | |||||||||
| Address1: | 9650 GROSS POINT RD STE 2900 | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600761214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478667846 | ||||||||
| FaxNumber: | 8668545815 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2007 | ||||||||
| LastUpdateDate: | 08/23/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 49765 | MN | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 036130340 | IL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 036.120340 | 01 | IL | STATE OF ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATIONS. | OTHER | 201114620 | 05 | IN | MEDICAID | 542125000 | 05 | MN | MEDICAID | 000000791353 | 01 | IN | ANTHEM BCBS | OTHER | 35273100 | 05 | WI | MEDICAID | ENROLLED | 05 | IA | MEDICAID |