Provider Demographics
NPI:1801852322
Name:BACH, MALGORZATA KRYSTYNA (MD)
Entity Type:Individual
Prefix:
First Name:MALGORZATA
Middle Name:KRYSTYNA
Last Name:BACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MALGORZATA
Other - Middle Name:KRYSTYNA
Other - Last Name:OCZKO-WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22285 PEPPER RD
Mailing Address - Street 2:STE 401
Mailing Address - City:LAKE BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010
Mailing Address - Country:US
Mailing Address - Phone:847-882-6604
Mailing Address - Fax:847-882-6228
Practice Address - Street 1:22285 PEPPER RD
Practice Address - Street 2:STE 401
Practice Address - City:LAKE BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010
Practice Address - Country:US
Practice Address - Phone:847-882-6604
Practice Address - Fax:847-882-6228
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361151942084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036115194Medicaid
ILI60957Medicare UPIN
ILK30605Medicare PIN