Healthcare Provider Details

I. General information

NPI: 1528246386
Provider Name (Legal Business Name): BARBARA G KIJEK MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 N DIVISION ST SUITE 303
MORRIS IL
60450-1182
US

IV. Provider business mailing address

1802 N DIVISION ST SUITE 303
MORRIS IL
60450-1182
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: BRENDA BERG
Title or Position: OFFICE MANAGER
Credential:
Phone: 815-942-0065