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General NPI Number Information
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NPI Number | 1922176841
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Entity Type | Organization
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Legal Business Name | MISN INC
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 08/04/2014
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Provider Practice Location Address
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Address Line | 5012 W.LAWRENCE AVE
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City | CHICAGO
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State | IL
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Zip | 60630
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Country | US
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Telephone | 773-205-2555
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Fax | 773-205-4439
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Provider Business Mailing Address
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Address Line | 5012 W. LAWRENCE AVE
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City | CHICAGO
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State | IL
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Zip | 60630
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Country | US
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Telephone | 773-205-2555
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Fax | 773-205-4439
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Authorized Official
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Title or Position | PRESIDENT
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Name | MALGORZATA SYPIEN
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Credential | MD
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Telephone | 773-205-2555
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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 | 036098339
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License Number State | IL
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