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General NPI Number Information
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NPI Number | 1457556508
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Entity Type | Organization
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Legal Business Name | DR KANIA FAMILY CARE, S.C.
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Dates
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Enumeration Date | 06/19/2007
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Last Update Date | 02/05/2008
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Provider Practice Location Address
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Address Line | 770 E NORTHWEST HWY
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City | MOUNT PROSPECT
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State | IL
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Zip | 60056-3464
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Country | US
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Telephone | 708-655-5099
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Fax |
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Provider Business Mailing Address
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Address Line | 8650 PALMER ST
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City | RIVER GROVE
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State | IL
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Zip | 60171-1908
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Country | US
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Telephone | 708-655-5099
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | AGNIESZKA KANIA
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Credential | M.D.
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Telephone | 708-655-5099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | IL
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