MEDICARE: URSZULA BOLENA JABLONSKA 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	036098806	IL

Other Identifiers

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

General Provider Information

NPI Number	:	1851303945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	URSZULA BOLENA JABLONSKA M.D.

Provider Business Mailing Address
First Line	:	5251 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630
Country	:	US
Telephone Number	:	773-283-9300
Fax Number	:	773-283-0098

Provider Business Practice Location Address
First Line	:	5605 W. GUNNISON ST.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630
Country	:	US
Telephone Number	:	773-545-2525
Fax Number	:	773-205-5700

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	01/15/2020

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