MEDICARE: JONATHAN PETER KOLAKOWSKI M.D.

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	2084P0800X	Psychiatry Physician	125060969	IL

General Provider Information

NPI Number	:	1710232889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN PETER KOLAKOWSKI M.D.

Provider Business Mailing Address
First Line	:	2331 W. HARRISON ST.
Second Line	:	APT. 3
City	:	CHICAGO
State	:	IL
Zip	:	60612
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2331 W. HARRISON ST.
Second Line	:	APT. 3
City	:	CHICAGO
State	:	IL
Zip	:	60612
Country	:	US
Telephone Number	:	847-997-2142
Fax Number	:

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

Provider Enumeration Date	:	07/16/2012
Last Update Date	:	07/16/2012

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