MEDICARE: ALICIA MARIE KARCZEWSKI DDS

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
1	122300000X	Dentist	019.032812	IL

General Provider Information

NPI Number	:	1285243675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA MARIE KARCZEWSKI DDS

Provider Business Mailing Address
First Line	:	202 FOREST EDGE DR
Second Line	:
City	:	PALOS PARK
State	:	IL
Zip	:	60464-1980
Country	:	US
Telephone Number	:	708-408-7134
Fax Number	:

Provider Business Practice Location Address
First Line	:	845 N MICHIGAN AVE STE 922E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2194
Country	:	US
Telephone Number	:	708-408-7134
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2020
Last Update Date	:	07/30/2020

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