MEDICARE: MALGORZATA SYPIEN 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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01632867	OTHER	IL	BC/BS

General Provider Information

NPI Number	:	1649443235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALGORZATA SYPIEN M.D.

Provider Business Mailing Address
First Line	:	5012 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-3800
Country	:	US
Telephone Number	:	773-205-2555
Fax Number	:

Provider Business Practice Location Address
First Line	:	5012 W LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-3800
Country	:	US
Telephone Number	:	773-205-2555
Fax Number	:

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

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

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