Healthcare Provider Details

I. General information

NPI: 1508822149
Provider Name (Legal Business Name): BARBARA G KIJEK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2006
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 N DIVISION ST SUITE 303
MORRIS IL
60450-1184
US

IV. Provider business mailing address

1802 N DIVISION ST SUITE 303
MORRIS IL
60450-1184
US

V. Phone/Fax

Practice location:
  • Phone: 815-942-0065
  • Fax: 815-942-1472
Mailing address:
  • Phone: 815-942-0065
  • Fax: 815-942-1472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036072885
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: