Healthcare Provider Details

I. General information

NPI: 1982048435
Provider Name (Legal Business Name): MALGORZATA A. KOCHANEK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2013
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 N NORTHWEST HWY STE 303
PARK RIDGE IL
60068-1460
US

IV. Provider business mailing address

210 S DESPLAINES ST
CHICAGO IL
60661-5500
US

V. Phone/Fax

Practice location:
  • Phone: 847-294-5160
  • Fax:
Mailing address:
  • Phone: 312-654-2720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036.140480
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: