Provider Demographics
NPI:1376745166
Name:NICEWICZ, MARIA JOLANTA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:JOLANTA
Last Name:NICEWICZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7447 W TALCOTT AVE STE 561
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3716
Mailing Address - Country:US
Mailing Address - Phone:773-467-8866
Mailing Address - Fax:773-467-8886
Practice Address - Street 1:7447 W TALCOTT AVE STE 561
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3716
Practice Address - Country:US
Practice Address - Phone:773-467-8866
Practice Address - Fax:773-467-8886
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036117003208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics