Healthcare Provider Details

I. General information

NPI: 1386853471
Provider Name (Legal Business Name): AGNES I WOJNARSKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 W PETERSON AVE STE 610
CHICAGO IL
60646-5728
US

IV. Provider business mailing address

4801 W PETERSON AVE STE 610
CHICAGO IL
60646-5728
US

V. Phone/Fax

Practice location:
  • Phone: 773-878-6200
  • Fax: 773-878-4513
Mailing address:
  • Phone: 773-878-6200
  • Fax: 773-878-4513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036122420
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: