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General NPI Number Information
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NPI Number | 1952278608
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Entity Type | Organization
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Legal Business Name | GREENLEAF MEMORY CLINIC PLLC
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Dates
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Enumeration Date | 10/18/2025
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Last Update Date | 10/18/2025
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Provider Practice Location Address
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Address Line | 355 GREENLEAF ST STE H
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City | PARK CITY
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State | IL
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Zip | 60085-5708
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Country | US
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Telephone | 608-320-9006
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Fax | 847-999-3859
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Provider Business Mailing Address
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Address Line | 355 GREENLEAF ST STE H
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City | PARK CITY
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State | IL
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Zip | 60085-5708
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Country | US
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Telephone | 608-320-9006
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Fax | 847-999-3859
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Authorized Official
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Title or Position | NEUROLOGY/PHYSICIAN/OWNER
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Name | MALGORZATA K BACH
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Credential | MD
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Telephone | 608-320-9006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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