Provider Demographics
NPI:1215200472
Name:OWERCZUK, MONICA (DO)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:OWERCZUK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 ARLINGTON HEIGHTS ROAD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007
Mailing Address - Country:US
Mailing Address - Phone:847-439-2315
Mailing Address - Fax:847-439-3935
Practice Address - Street 1:31 ARLINGTON HEIGHTS ROAD
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007
Practice Address - Country:US
Practice Address - Phone:847-439-2315
Practice Address - Fax:847-439-3935
Is Sole Proprietor?:No
Enumeration Date:2012-02-20
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010229712085R0202X
IL0361383702085R0202X
390200000X
IL036.1383702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program