Provider Demographics
NPI:1467560961
Name:MAJKA-KRAVETS, ZDZISLAWA TERESA (MD)
Entity Type:Individual
Prefix:
First Name:ZDZISLAWA
Middle Name:TERESA
Last Name:MAJKA-KRAVETS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 THEODORE STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435
Mailing Address - Country:US
Mailing Address - Phone:815-744-5550
Mailing Address - Fax:815-744-5428
Practice Address - Street 1:3100 THEODORE STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435
Practice Address - Country:US
Practice Address - Phone:815-744-5550
Practice Address - Fax:815-744-5428
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085034207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036085034Medicaid
G15864Medicare UPIN
IL036085034Medicaid
ILL87163Medicare PIN
ILL39284Medicare PIN