Provider Demographics
NPI:1174637326
Name:OSOLKOWSKI, EWA (MD)
Entity Type:Individual
Prefix:DR
First Name:EWA
Middle Name:
Last Name:OSOLKOWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EWA
Other - Middle Name:
Other - Last Name:JACHIMOWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1634 W 14TYH PLACE UHS
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:630-571-2004
Mailing Address - Fax:
Practice Address - Street 1:1634 W.POLK STR.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-829-4224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-106097207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILI 03977Medicare UPIN