1245274406 NPI number — MARY C OLSZEWSKI D.P.M.

Table of content: MARY C OLSZEWSKI D.P.M. (NPI 1245274406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245274406 NPI number — MARY C OLSZEWSKI D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OLSZEWSKI
Provider First Name:
MARY
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
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:
1245274406
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
434 E PALATINE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALATINE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60074-5119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-398-0900
Provider Business Mailing Address Fax Number:
847-398-0973

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
434 E PALATINE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALATINE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60074-5119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-398-0900
Provider Business Practice Location Address Fax Number:
847-398-0973
Provider Enumeration Date:
06/16/2006

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: 213ES0131X , with the licence number:  016004266 , 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)

  • Identifier: 016004266 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 941283 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0001623060 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 480032539 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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