Healthcare Provider Details

I. General information

NPI: 1538238860
Provider Name (Legal Business Name): KAREN CERVENKA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W NORTH AVE
MELROSE PARK IL
60160-1612
US

IV. Provider business mailing address

33786 TREASURY CTR
CHICAGO IL
60694-3700
US

V. Phone/Fax

Practice location:
  • Phone: 708-681-3200
  • Fax: 708-681-5228
Mailing address:
  • Phone: 708-460-7444
  • Fax: 708-460-8662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036065651
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: