MEDICARE: HANNA JASINSKA MDSC

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	036-074886	IL

General Provider Information

NPI Number	:	1225203227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANNA JASINSKA MDSC

Provider Business Mailing Address
First Line	:	5632 W LAWRENCE AVE
Second Line	:	SUITE #1
City	:	CHICAGO
State	:	IL
Zip	:	60630-3220
Country	:	US
Telephone Number	:	773-286-5585
Fax Number	:	773-286-9602

Provider Business Practice Location Address
First Line	:	5632 W LAWRENCE AVE
Second Line	:	SUITE #1
City	:	CHICAGO
State	:	IL
Zip	:	60630-3220
Country	:	US
Telephone Number	:	773-286-5585
Fax Number	:	773-286-9602

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	HANNA JOZEFA JASINSKA
Credential	:	M.D.
Telephone Number	:	773-286-5585

Provider Enumeration Date	:	04/30/2008
Last Update Date	:	04/30/2008

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