MEDICARE: HANNA JOZEFA JASINSKA 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		IL

General Provider Information

NPI Number	:	1902010630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNA JOZEFA JASINSKA M.D.

Provider Business Mailing Address
First Line	:	5632 W LAWRENCE AVE
Second Line	:	SUITE #1
City	:	CHICAGO
State	:	IL
Zip	:	60630-3220
Country	:	US
Telephone Number	:	773-286-5585
Fax Number	:	773-286-9602

Provider Business Practice Location Address
First Line	:	5632 W LAWRENCE AVE
Second Line	:	SUITE #1
City	:	CHICAGO
State	:	IL
Zip	:	60630-3220
Country	:	US
Telephone Number	:	773-286-5585
Fax Number	:	773-286-9602

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

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	07/08/2007

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