Organization
FOX VALLEY ADULT AND PEDIATRIC MEDICINE PC
Active
Organization
FOX VALLEY ADULT AND PEDIATRIC MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ZBIGNIEW MARIAN CIECHANOWSKI M.D. (CEO)
(630) 513-0298
Entity
Organization
Contact information
Practice address
2020 DEAN ST. STE G, ST. CHARLES, IL 60174-1665
(630) 513-0298
Mailing address
2020 DEAN ST. STE G, ST. CHARLES, IL 60174-1665
(630) 513-0298
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
IL
208000000X
Pediatrics Physician
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04532182
BLUE CROSS BLUE SHIELD IL
IL
01
—
E94586
UPIN
—
Enumeration date
01/03/2008
Last updated
03/31/2008
Update your record
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