MEDICARE: EUGENIA GROCHOWSKA MD

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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	21609795	OTHER	IL	BLUE CROSS BLUE SHIELD OF ILLINOIS

General Provider Information

NPI Number	:	1396007456
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EUGENIA GROCHOWSKA MD

Provider Business Mailing Address
First Line	:	5647 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-3219
Country	:	US
Telephone Number	:	773-545-5252
Fax Number	:	773-545-5671

Provider Business Practice Location Address
First Line	:	5647 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-3219
Country	:	US
Telephone Number	:	773-545-5252
Fax Number	:	773-545-5671

Authorized Official
Title or Position	:	OWNER
Name	:	EUGENIA GROCHOWSKA
Credential	:	M.D.
Telephone Number	:	773-545-5252

Provider Enumeration Date	:	06/13/2012
Last Update Date	:	06/13/2012

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