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NPI Code Detail

MEDICARE: NOWOBILSKA MEDICAL PRACTICE LTD

MEDICARE: NOWOBILSKA MEDICAL PRACTICE LTD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QP2300XPrimary Care Clinic/Center036070270IL

General Provider Information

NPI Number : 1013217785
Entity Type Code : Organization
Provider Name (Legal Business Name) : NOWOBILSKA MEDICAL PRACTICE LTD
Provider Business Mailing Address
First Line : 5257 S CICERO AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60632-4915
Country : US
Telephone Number : 773-735-8038
Fax Number :
Provider Business Practice Location Address
First Line : 5257 S CICERO AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60632-4915
Country : US
Telephone Number : 773-735-8038
Fax Number : 800-640-0772
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. CASEY MALIK
Credential :
Telephone Number : 773-735-8182
Provider Enumeration Date : 10/28/2010
Last Update Date : 02/09/2011

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Directions to “NOWOBILSKA MEDICAL PRACTICE LTD ” Practice Location

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