Healthcare Provider Details

I. General information

NPI: 1821384710
Provider Name (Legal Business Name): MAGDALENA A. KOBIERSKA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N RANDALL RD STE 400
ELGIN IL
60123-7805
US

IV. Provider business mailing address

1550 S. BLUE ISLAND UNIT 906
CHICAGO IL
60608
US

V. Phone/Fax

Practice location:
  • Phone: 847-381-8899
  • Fax:
Mailing address:
  • Phone: 773-934-0126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036-135603
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: