MEDICARE: REGINA DZIEWIOR MA

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	237600000X	Audiologist-Hearing Aid Fitter	147000541	IL

General Provider Information

NPI Number	:	1467446583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA DZIEWIOR MA

Provider Business Mailing Address
First Line	:	305 E NORTHWEST HWY
Second Line	:
City	:	PALATINE
State	:	IL
Zip	:	60067-8116
Country	:	US
Telephone Number	:	847-358-2896
Fax Number	:	847-358-5896

Provider Business Practice Location Address
First Line	:	305 E NORTHWEST HWY
Second Line	:
City	:	PALATINE
State	:	IL
Zip	:	60067-8116
Country	:	US
Telephone Number	:	847-358-2896
Fax Number	:	847-358-5896

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

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	02/08/2019

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