Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 046010172 | IL |
NPI | 1013161710 |
---|---|
Provider Name | Malgorzata Kiwacz |
First Address | Skokie, IL 60076-1224 |
Second Address | Skokie, IL 60076-1224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2008 |
Last Update Date | 06/11/2008 |