Provider Demographics
NPI:1053500843
Name:URSULA GIERLACHOWSKI MD
Entity Type:Organization
Organization Name:URSULA GIERLACHOWSKI MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:URSULA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIERLACHOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-581-6336
Mailing Address - Street 1:5332 S ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-4949
Mailing Address - Country:US
Mailing Address - Phone:773-581-6336
Mailing Address - Fax:
Practice Address - Street 1:5332 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-4949
Practice Address - Country:US
Practice Address - Phone:773-581-6336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01605562OtherBCBS
1679629976OtherINDIVIDUAL NPI
IL345520Medicare PIN
IL01605562OtherBCBS