Provider Demographics
NPI:1760552681
Name:JASKOWIAK, NORA TERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:NORA
Middle Name:TERESA
Last Name:JASKOWIAK
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 1:5841 S MARYLAND AVE # MC5031
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1447
Mailing Address - Country:US
Mailing Address - Phone:773-702-2048
Mailing Address - Fax:773-834-4022
Practice Address - Street 1:5841 S. MARYLAND AVE
Practice Address - Street 2:MC 5031
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637
Practice Address - Country:US
Practice Address - Phone:773-702-2048
Practice Address - Fax:773-834-4022
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL362177139282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036097897OtherSTATE MEDICAL LICENSE