Healthcare Provider Details

I. General information

NPI: 1326093576
Provider Name (Legal Business Name): ELEONORA KUL-LIPSKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7447 W TALCOTT AVE STE 269
CHICAGO IL
60631-3718
US

IV. Provider business mailing address

7447 W TALCOTT AVE STE 269
CHICAGO IL
60631-3718
US

V. Phone/Fax

Practice location:
  • Phone: 708-456-3500
  • Fax: 708-453-6907
Mailing address:
  • Phone: 708-456-3500
  • Fax: 708-453-6907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number042616880
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: