1861596900 NPI number — MRS. WENDY KAZIMIR DUMONSKI ORTL

Table of content: MRS. WENDY KAZIMIR DUMONSKI ORTL (NPI 1861596900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861596900 NPI number — MRS. WENDY KAZIMIR DUMONSKI ORTL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUMONSKI
Provider First Name:
WENDY
Provider Middle Name:
KAZIMIR
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ORTL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KAZIMIR
Provider Other First Name:
WENDY
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTRL
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861596900
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
514 WENONAH AVE
Provider Second Line Business Mailing Address:
#35
Provider Business Mailing Address City Name:
OAK PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-925-8816
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5820 W IRVING PARK RD
Provider Second Line Business Practice Location Address:
VITAL REHABILITATION
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-685-8482
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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