MEDICARE: MONICA ANN MOZWECZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036072941	IL

General Provider Information

NPI Number	:	1083756050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA ANN MOZWECZ M.D.

Provider Business Mailing Address
First Line	:	1860 PAYSPHERE CIR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-0018
Country	:	US
Telephone Number	:	708-246-4155
Fax Number	:	708-246-9489

Provider Business Practice Location Address
First Line	:	5600 WOLF RD
Second Line	:	SUITE 110
City	:	WESTERN SPRINGS
State	:	IL
Zip	:	60558-2254
Country	:	US
Telephone Number	:	708-246-4155
Fax Number	:	708-246-9489

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	12/11/2012

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