Provider Demographics
NPI:1659336519
Name:KIJEK, MARK A (MD SC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:KIJEK
Suffix:
Gender:M
Credentials:MD SC
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:60450-1182
Mailing Address - Country:US
Mailing Address - Phone:815-942-1203
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:60450-1182
Practice Address - Country:US
Practice Address - Phone:815-942-1203
Practice Address - Fax:815-942-1472
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036067399207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360673991Medicaid
IL3200046OtherBCBS
741511Medicare ID - Type Unspecified
IL0360673991Medicaid