Provider Demographics
NPI:1093802712
Name:KRASKA-CWIKLA, ALICJA (MD)
Entity Type:Individual
Prefix:
First Name:ALICJA
Middle Name:
Last Name:KRASKA-CWIKLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15614 S HARLEM AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4402
Mailing Address - Country:US
Mailing Address - Phone:708-444-0097
Mailing Address - Fax:708-444-8252
Practice Address - Street 1:15614 S HARLEM AVE
Practice Address - Street 2:SUITE D
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4402
Practice Address - Country:US
Practice Address - Phone:708-444-0097
Practice Address - Fax:708-444-8252
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36099771207R00000X
NC200000859207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH19712Medicare UPIN
ILK25140Medicare ID - Type Unspecified