Healthcare Provider Details

I. General information

NPI: 1295853380
Provider Name (Legal Business Name): JUREK AND JUREK FAMILY PRACTICE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5059 W 111TH ST
ALSIP IL
60803-6074
US

IV. Provider business mailing address

5059 W 111TH ST
ALSIP IL
60803-6074
US

V. Phone/Fax

Practice location:
  • Phone: 708-425-1300
  • Fax: 708-425-3443
Mailing address:
  • Phone: 708-425-1300
  • Fax: 708-425-3443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036081828
License Number StateIL

VIII. Authorized Official

Name: MR. MARZENA A. MISKOWIEC
Title or Position: OFFICE MANAGER
Credential:
Phone: 708-415-3705