Organization
JAROSLAUS T IWANETZ MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BOHDAN A IWANETZ MD (PHYSICIAN SECRETARY OF CORP)
(708) 841-1121
Entity
Organization
Contact information
Practice address
713 E 142ND ST, DOLTON, IL 60419-1062
(708) 841-1121
(708) 841-6976
Mailing address
713 E 142ND ST, DOLTON, IL 60419-1062
(708) 841-1121
(708) 841-6976
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
042003889
IL
208600000X
Surgery Physician
Primary
042003889
IL
Other
Enumeration date
08/21/2006
Last updated
06/23/2008
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