1245340637 NPI number — MRS. DAWN DENISESINICKI BANCSI MPT

Table of content: MRS. DAWN DENISESINICKI BANCSI MPT (NPI 1245340637)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245340637 NPI number — MRS. DAWN DENISESINICKI BANCSI MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BANCSI
Provider First Name:
DAWN
Provider Middle Name:
DENISESINICKI
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SINICKI
Provider Other First Name:
DAWN
Provider Other Middle Name:
DENISE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245340637
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5271 N JOHNSON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MICHIGAN CITY
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46360-9377
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-567-3891
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6775 PROSPERI DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TINLEY PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60477-4789
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-429-1260
Provider Business Practice Location Address Fax Number:
708-429-6622
Provider Enumeration Date:
08/30/2006

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: 2251N0400X , 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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