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General NPI Number Information
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NPI Number | 1558546952
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Entity Type | Organization
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Legal Business Name | FOX VALLEY ADULT AND PEDIATRIC MEDICINE PC
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Dates
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Enumeration Date | 01/03/2008
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Last Update Date | 03/31/2008
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Provider Practice Location Address
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Address Line | 2020 DEAN ST. STE G
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City | ST. CHARLES
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State | IL
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Zip | 60174-1665
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Country | US
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Telephone | 630-513-0298
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Fax |
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Provider Business Mailing Address
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Address Line | 2020 DEAN ST. STE G
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City | ST. CHARLES
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State | IL
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Zip | 60174-1665
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Country | US
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Telephone | 630-513-0298
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. ZBIGNIEW MARIAN CIECHANOWSKI
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Credential | M.D.
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Telephone | 630-513-0298
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | IL
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