Healthcare Provider Details

I. General information

NPI: 1295655249
Provider Name (Legal Business Name): MARGARET O'MALLEY KOTOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 ROGERS ST FL 2
DOWNERS GROVE IL
60515-3774
US

IV. Provider business mailing address

2634 W FARWELL AVE
CHICAGO IL
60645-4523
US

V. Phone/Fax

Practice location:
  • Phone: 630-528-8855
  • Fax:
Mailing address:
  • Phone: 773-984-7851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: