MEDICARE: DR. JUSTYNA BANCEREK-STENGELE MD

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	036108278	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336194315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTYNA BANCEREK-STENGELE MD

Provider Business Mailing Address
First Line	:	1206 E 9TH ST
Second Line	:	STE 210
City	:	LOCKPORT
State	:	IL
Zip	:	60441-2404
Country	:	US
Telephone Number	:	815-834-8777
Fax Number	:

Provider Business Practice Location Address
First Line	:	1206 E 9TH ST
Second Line	:	STE 210
City	:	LOCKPORT
State	:	IL
Zip	:	60441-2404
Country	:	US
Telephone Number	:	815-834-8777
Fax Number	:

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	11/23/2011

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