MEDICARE: DR. ANNA MIANOWSKA M.D., PH.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	208D00000X	General Practice Physician	036-057827	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001623407	OTHER	IL	BLUE CROSS - BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871635078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNA MIANOWSKA M.D., PH.D.

Provider Business Mailing Address
First Line	:	6039 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-5150
Country	:	US
Telephone Number	:	847-266-9550
Fax Number	:	847-266-9144

Provider Business Practice Location Address
First Line	:	6039 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-5116
Country	:	US
Telephone Number	:	773-622-6095
Fax Number	:	773-622-8706

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	10/10/2018

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