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
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