MEDICARE: MISN INC

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	036098339	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01632867	OTHER	IL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922176841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISN INC

Provider Business Mailing Address
First Line	:	5012 W. LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630
Country	:	US
Telephone Number	:	773-205-2555
Fax Number	:	773-205-4439

Provider Business Practice Location Address
First Line	:	5012 W.LAWRENCE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630
Country	:	US
Telephone Number	:	773-205-2555
Fax Number	:	773-205-4439

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MALGORZATA SYPIEN
Credential	:	MD
Telephone Number	:	773-205-2555

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	08/04/2014

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