Healthcare Provider Details

I. General information

NPI: 1609090224
Provider Name (Legal Business Name): JONI J. GLIWA LOT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

10310 S KNOX AVE
OAK LAWN IL
60453-4729
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-1323
  • Fax: 708-684-1780
Mailing address:
  • Phone: 708-636-0731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283XC2000X
TaxonomyChildren's Rehabilitation Hospital
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: