Provider Demographics
NPI:1598039711
Name:KANISZEWSKA, MONIKA D (MD)
Entity Type:Individual
Prefix:DR
First Name:MONIKA
Middle Name:D
Last Name:KANISZEWSKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:275 PARKWAY DR STE 521
Practice Address - Street 2:
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-4344
Practice Address - Country:US
Practice Address - Phone:847-459-6400
Practice Address - Fax:847-459-4610
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.137366207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology