Healthcare Provider Details

I. General information

NPI: 1699701052
Provider Name (Legal Business Name): NOWOBILSKA MEDICAL PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5257 S CICERO AVE
CHICAGO IL
60632-4915
US

IV. Provider business mailing address

5257 S CICERO AVE
CHICAGO IL
60632-4915
US

V. Phone/Fax

Practice location:
  • Phone: 773-735-8038
  • Fax: 773-735-8297
Mailing address:
  • Phone: 773-735-8038
  • Fax: 773-735-8297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. ANNA NOWOBILSKA
Title or Position: OWNER
Credential: M.D.
Phone: 773-735-8038