1033254461 NPI number — MISS KRISTINA MARIE SPYCHALSKI MOTRL

Table of content: MISS KRISTINA MARIE SPYCHALSKI MOTRL (NPI 1033254461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033254461 NPI number — MISS KRISTINA MARIE SPYCHALSKI MOTRL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPYCHALSKI
Provider First Name:
KRISTINA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MOTRL
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:
1033254461
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11824 SOUTHWEST HWY
Provider Second Line Business Mailing Address:
STE 230
Provider Business Mailing Address City Name:
PALOS HEIGHTS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60463-1055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-671-1175
Provider Business Mailing Address Fax Number:
708-671-1176

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11824 SOUTHWEST HWY
Provider Second Line Business Practice Location Address:
STE 230
Provider Business Practice Location Address City Name:
PALOS HEIGHTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60463-1055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-671-1175
Provider Business Practice Location Address Fax Number:
708-671-1176
Provider Enumeration Date:
02/21/2007

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: 225XP0200X , with the licence number:  056.007265 , 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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