Provider Demographics
NPI:1508822149
Name:KIJEK, BARBARA G (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:G
Last Name:KIJEK
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 1:1802 N DIVISION ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-1184
Mailing Address - Country:US
Mailing Address - Phone:815-942-0065
Mailing Address - Fax:815-942-1472
Practice Address - Street 1:1802 N DIVISION ST
Practice Address - Street 2:SUITE 303
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1184
Practice Address - Country:US
Practice Address - Phone:815-942-0065
Practice Address - Fax:815-942-1472
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036072885208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3200049OtherBCBS
IL0360728851Medicaid
C49088Medicare UPIN
IL0360728851Medicaid