MEDICARE: ANDREW & LUBOMYRA KAZANIWSKYJ DO

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

General Provider Information

NPI Number	:	1649697483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDREW & LUBOMYRA KAZANIWSKYJ DO

Provider Business Mailing Address
First Line	:	11747 SOUTHWEST HWY
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1015
Country	:	US
Telephone Number	:	708-671-0990
Fax Number	:	708-671-0994

Provider Business Practice Location Address
First Line	:	11747 SOUTHWEST HWY
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1015
Country	:	US
Telephone Number	:	708-671-0990
Fax Number	:	708-671-0994

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANDREW L KAZANIWSKYJ
Credential	:	DO
Telephone Number	:	708-671-0990

Provider Enumeration Date	:	03/18/2014
Last Update Date	:	03/18/2014

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