Healthcare Provider Details

I. General information

NPI: 1295091403
Provider Name (Legal Business Name): KAROLINA WOLOSZYN MACHNICA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 WAUKEGAN RD STE 140
BANNOCKBURN IL
60015-1868
US

IV. Provider business mailing address

2151 WAUKEGAN RD STE 140
BANNOCKBURN IL
60015-1868
US

V. Phone/Fax

Practice location:
  • Phone: 847-444-1830
  • Fax:
Mailing address:
  • Phone: 847-663-8540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number036143084
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: