Healthcare Provider Details

I. General information

NPI: 1275979692
Provider Name (Legal Business Name): KATARZYNA KACZMARCZYK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N WINFIELD RD STE 202
WINFIELD IL
60190-1379
US

IV. Provider business mailing address

25 N WINFIELD RD STE 202
WINFIELD IL
60190-1379
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-4700
  • Fax: 630-933-4427
Mailing address:
  • Phone: 630-933-4700
  • Fax: 630-933-4427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberM-15136
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD201505
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036164796
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: