MEDICARE: NOWOBILSKA MEDICAL PRACTICE

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	173000000X	Legal Medicine		IL

General Provider Information

NPI Number	:	1699701052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOWOBILSKA MEDICAL PRACTICE

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	:	773-735-8297

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	:	773-735-8297

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANNA NOWOBILSKA
Credential	:	M.D.
Telephone Number	:	773-735-8038

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	08/22/2020

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