Healthcare Provider Details

I. General information

NPI: 1972246692
Provider Name (Legal Business Name): MAGDALENA PIEROZEK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 04/20/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 KILPATRICK AVE
OAK LAWN IL
60453-6200
US

IV. Provider business mailing address

8105 W 98TH ST
PALOS HILLS IL
60465-1449
US

V. Phone/Fax

Practice location:
  • Phone: 708-424-2000
  • Fax:
Mailing address:
  • Phone: 773-807-6615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number242006414
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: