Provider Demographics
NPI:1851303945
Name:JABLONSKA, URSZULA BOLENA (MD)
Entity Type:Individual
Prefix:
First Name:URSZULA
Middle Name:BOLENA
Last Name:JABLONSKA
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 1:5251 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630
Mailing Address - Country:US
Mailing Address - Phone:773-283-9300
Mailing Address - Fax:773-283-0098
Practice Address - Street 1:5605 W. GUNNISON ST.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630
Practice Address - Country:US
Practice Address - Phone:773-545-2525
Practice Address - Fax:773-205-5700
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098806207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036098806Medicaid
IL205074Medicare ID - Type Unspecified