Healthcare Provider Details

I. General information

NPI: 1649492331
Provider Name (Legal Business Name): STEVEN MAREK KARKOWSKI P.T.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S RIVERSIDE PLZ SUITE 830
CHICAGO IL
60606-5808
US

IV. Provider business mailing address

785 LEAHY CIR
DES PLAINES IL
60016-2827
US

V. Phone/Fax

Practice location:
  • Phone: 312-416-3804
  • Fax:
Mailing address:
  • Phone: 847-521-2158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: