MEDICARE: MALGORZATA HELENA CUDZICH NOWAKOWSKI

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	209029723	IL
2	363LF0000X	Family Nurse Practitioner	209029723	IL

General Provider Information

NPI Number	:	1659120111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALGORZATA HELENA CUDZICH NOWAKOWSKI

Provider Business Mailing Address
First Line	:	1350 W LAKE ST UNIT 1
Second Line	:
City	:	MELROSE PARK
State	:	IL
Zip	:	60160-4042
Country	:	US
Telephone Number	:	630-229-5444
Fax Number	:	708-615-7547

Provider Business Practice Location Address
First Line	:	1350 W LAKE ST UNIT 1
Second Line	:
City	:	MELROSE PARK
State	:	IL
Zip	:	60160-4042
Country	:	US
Telephone Number	:	708-343-8512
Fax Number	:	708-343-8529

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

Provider Enumeration Date	:	05/16/2024
Last Update Date	:	05/16/2024

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Directions to “ MALGORZATA HELENA CUDZICH NOWAKOWSKI ” Practice Location

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