Healthcare Provider Details

I. General information

NPI: 1255109997
Provider Name (Legal Business Name): MALGORZATA SUROWIEC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2023
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2313 S MOUNT PROSPECT RD
DES PLAINES IL
60018-1811
US

IV. Provider business mailing address

176 ABBEYWOOD CIR
STREAMWOOD IL
60107-1093
US

V. Phone/Fax

Practice location:
  • Phone: 847-635-3000
  • Fax: 877-566-9387
Mailing address:
  • Phone: 630-670-5166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number051298294
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: