Provider Demographics
NPI:1275505513
Name:KWASIBORSKI, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:KWASIBORSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 COMMERCE DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-7807
Mailing Address - Country:US
Mailing Address - Phone:847-548-3458
Mailing Address - Fax:847-548-3459
Practice Address - Street 1:15 COMMERCE DR
Practice Address - Street 2:SUITE 109
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-7807
Practice Address - Country:US
Practice Address - Phone:847-548-3458
Practice Address - Fax:847-548-3459
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056-007-0802083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine