Organization
MARY GAIL KWIECINSKI DPM P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY GAIL KWIECINSKI DPM (OWNER/PRESIDENT)
(847) 816-3156
Entity
Organization
Contact information
Practice address
1870 W WINCHESTER RD STE 246, LIBERTYVILLE, IL 60048-5360
(847) 816-3156
(847) 816-9724
Mailing address
1870 W WINCHESTER RD STE 246, LIBERTYVILLE, IL 60048-5360
(847) 816-3156
(847) 816-9724
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4933497
BLUE CROSS BLUE SHIELD
IL
01
—
DR4991
MEDICARE RAILROAD
IL
Enumeration date
11/10/2010
Last updated
12/28/2021
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