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NPI Code Detail

MEDICARE: DR. ELIZABETH STELLA PODCZERWINSKI M.D.

MEDICARE: DR. ELIZABETH STELLA PODCZERWINSKI 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
1390200000XStudent in an Organized Health Care Education/Training Program
2208600000XSurgery Physician125058202IL

General Provider Information

NPI Number : 1841519238
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELIZABETH STELLA PODCZERWINSKI M.D.
Provider Business Mailing Address
First Line : 836 W WELLINGTON AVE
Second Line : ROOM 4807
City : CHICAGO
State : IL
Zip : 60657-5147
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 836 W WELLINGTON AVE
Second Line : ROOM 4807
City : CHICAGO
State : IL
Zip : 60657-5147
Country : US
Telephone Number : 773-296-7093
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2010
Last Update Date : 06/09/2010

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