Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 036074324 | IL |
NPI | 1275627614 |
---|---|
Provider Name | Dr. Zofia Cygan |
First Address | Lisle, IL 60532-3199 |
Second Address | Lisle, IL 60532-3199 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 16/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3644117376054001 | (05) | IL |
C42772 | (02) |