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General NPI Number Information
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NPI Number | 1922160365
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Entity Type | Individual
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Provider Name | JOLANTA DZIOK M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 10/04/2012
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Provider Practice Location Address
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Address Line | 7447 W TALCOTT AVE SUTE 509
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City | CHICAGO
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State | IL
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Zip | 60631-3745
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Country | US
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Telephone | 773-792-2939
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Fax | 773-792-3214
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Provider Business Mailing Address
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Address Line | 11252 W ALEXANDRIA LN
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City | WESTCHESTER
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State | IL
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Zip | 60154-5934
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Country | US
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Telephone | 708-562-5132
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 036055387
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License Number State | IL
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