MEDICARE: AGNIESZKA OSIKA DMD, LTD

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	1223G0001X	General Practice Dentistry	019028023	IL

General Provider Information

NPI Number	:	1437486446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGNIESZKA OSIKA DMD, LTD

Provider Business Mailing Address
First Line	:	6101 W DAKIN ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-2537
Country	:	US
Telephone Number	:	773-343-3811
Fax Number	:

Provider Business Practice Location Address
First Line	:	6101 W DAKIN ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-2537
Country	:	US
Telephone Number	:	773-343-3811
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	AGNIESZKA OSIKA
Credential	:	DMD
Telephone Number	:	773-343-3811

Provider Enumeration Date	:	11/11/2009
Last Update Date	:	11/11/2009

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