1053842443 NPI number — DR. KAROLINA SABALIAUSKAITE M.D.

Table of content: DR. KAROLINA SABALIAUSKAITE M.D. (NPI 1053842443)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053842443 NPI number — DR. KAROLINA SABALIAUSKAITE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SABALIAUSKAITE
Provider First Name:
KAROLINA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053842443
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2160 S 1ST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYWOOD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60153-3328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-327-9124
Provider Business Mailing Address Fax Number:
708-327-9132

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2160 S 1ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAYWOOD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60153-3328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-327-9124
Provider Business Practice Location Address Fax Number:
708-327-9132
Provider Enumeration Date:
03/27/2017

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: 208000000X , with the licence number:  1053842243 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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