Healthcare Provider Details

I. General information

NPI: 1649443235
Provider Name (Legal Business Name): MALGORZATA SYPIEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2008
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5012 W LAWRENCE AVE
CHICAGO IL
60630-3800
US

IV. Provider business mailing address

5012 W LAWRENCE AVE
CHICAGO IL
60630-3800
US

V. Phone/Fax

Practice location:
  • Phone: 773-205-2555
  • Fax:
Mailing address:
  • Phone: 773-205-2555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: