Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 019.028031 | IL |
Y | 213EG0000X | General Practice | 019.028031 | IL |
NPI | 1003049412 |
---|---|
Provider Name | Dr. Maria Borzecka |
First Address | Chicago, IL 60641-4730 |
Second Address | Chicago, IL 60641-4730 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2009 |
Last Update Date | 01/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
019.028031 | LICENSE NUMBER (01) | IL |