Healthcare Provider Details

I. General information

NPI: 1336923945
Provider Name (Legal Business Name): MICHALINA CHRISTINA KORONKOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST STE 3200W
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

1714 RAWSON AVE
SOUTH MILWAUKEE WI
53172-1848
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-4050
  • Fax: 312-996-4019
Mailing address:
  • Phone: 414-750-5268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209028538
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: