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NPI Code Detail

MEDICARE: SARA JO KOWALCZUK NP

MEDICARE: SARA JO KOWALCZUK NP
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
1363LA2100XAcute Care Nurse Practitioner209-001291IL

General Provider Information

NPI Number : 1871675561
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARA JO KOWALCZUK NP
Provider Business Mailing Address
First Line : 233 E SUPERIOR ST FL 1
Second Line :
City : CHICAGO
State : IL
Zip : 60611-2913
Country : US
Telephone Number : 312-926-5741
Fax Number : 312-926-4343
Provider Business Practice Location Address
First Line : 233 E SUPERIOR ST FL 1
Second Line :
City : CHICAGO
State : IL
Zip : 60611-2913
Country : US
Telephone Number : 312-926-5741
Fax Number : 312-926-4343
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2006
Last Update Date : 12/13/2019

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