Provider Demographics
NPI:1225203227
Name:HANNA JASINSKA MDSC
Entity Type:Organization
Organization Name:HANNA JASINSKA MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:HANNA
Authorized Official - Middle Name:JOZEFA
Authorized Official - Last Name:JASINSKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-286-5585
Mailing Address - Street 1:5632 W LAWRENCE AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-3220
Mailing Address - Country:US
Mailing Address - Phone:773-286-5585
Mailing Address - Fax:773-286-9602
Practice Address - Street 1:5632 W LAWRENCE AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-3220
Practice Address - Country:US
Practice Address - Phone:773-286-5585
Practice Address - Fax:773-286-9602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-074886207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211417Medicare PIN
ILC49499Medicare UPIN