Organization
DRS. MATTANA AND KWIECINSKI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY GAIL KWIECINSKI D.P.M. (PARTNER)
(847) 816-4711
Entity
Organization
Contact information
Practice address
250 CENTER DR, SUITE 201, VERNON HILLS, IL 60061-1582
(847) 816-4711
(847) 247-1158
Mailing address
250 CENTER DR, SUITE 201, VERNON HILLS, IL 60061-1582
(847) 816-4711
(847) 247-1158
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
016004013
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004932354
BLUE CROSS BLUE SHIELD
IL
01
—
DP7858
RAILROAD MEDICARE
IL
Enumeration date
11/15/2006
Last updated
03/01/2010
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