Provider Demographics
NPI:1679629976
Name:GIERLACHOWSKI, URSULA (MD)
Entity Type:Individual
Prefix:DR
First Name:URSULA
Middle Name:
Last Name:GIERLACHOWSKI
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 1:5332 S ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-4949
Mailing Address - Country:US
Mailing Address - Phone:773-581-6336
Mailing Address - Fax:773-581-3638
Practice Address - Street 1:5332 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-4949
Practice Address - Country:US
Practice Address - Phone:773-581-6336
Practice Address - Fax:773-581-3638
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01605562OtherBCBS
IL01605562OtherBCBS
IL345520Medicare PIN