Individual
DR. JACQUELINE WILNEFF PONCZEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D., M.S.
Contact information
Practice address
225 E CHICAGO AVE, CHICAGO, IL 60611-2991
(800) 543-7362
Mailing address
2950 N SHERIDAN RD APT 802, CHICAGO, IL 60657-0951
(847) 436-0847
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036148403
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036148403
—
IL
Enumeration date
03/22/2016
Last updated
12/29/2020
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