Healthcare Provider Details

I. General information

NPI: 1811202690
Provider Name (Legal Business Name): MALGORZATA SOKOLOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2010
Last Update Date: 08/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 DEMPSTER ST
PARK RIDGE IL
60068-1143
US

IV. Provider business mailing address

8618 CAREY AVE
RIVER GROVE IL
60171-1637
US

V. Phone/Fax

Practice location:
  • Phone: 847-723-0260
  • Fax:
Mailing address:
  • Phone: 708-296-9066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number209.007983041.322873
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: