Healthcare Provider Details

I. General information

NPI: 1720259617
Provider Name (Legal Business Name): ALEKSANDRA GMURCZYK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 N FAIRBANKS CT 4-500
CHICAGO IL
60611-3013
US

IV. Provider business mailing address

710 N FAIRBANKS CT 4-500
CHICAGO IL
60611-3013
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-4945
  • Fax: 312-926-4885
Mailing address:
  • Phone: 312-695-4945
  • Fax: 312-926-4885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036115632
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: