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NPI Code Detail

MEDICARE: JOSEPHINE DLUGOPOLSKI-GACH MD

MEDICARE: JOSEPHINE DLUGOPOLSKI-GACH MD
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
1208000000XPediatrics Physician36112666IL
2207R00000XInternal Medicine Physician36112666IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679543151
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPHINE DLUGOPOLSKI-GACH MD
Provider Business Mailing Address
First Line : 2160 S FIRST AVE
Second Line : (9608 ROBERTS RD, HICKORY HILLS, ILLINOIS 60457)
City : MAYWOOD
State : IL
Zip : 60153
Country : US
Telephone Number : 708-233-5333
Fax Number : 708-233-5348
Provider Business Practice Location Address
First Line : 2160 S FIRST AVE
Second Line : (9608 ROBERTS RD, HICKORY HILLS, ILLINOIS 60457)
City : MAYWOOD
State : IL
Zip : 60153
Country : US
Telephone Number : 708-233-5333
Fax Number : 708-233-5348
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2006
Last Update Date : 06/28/2021

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