Provider Demographics
NPI:1871674267
Name:PODGORSKA, HELENA (MD)
Entity Type:Individual
Prefix:
First Name:HELENA
Middle Name:
Last Name:PODGORSKA
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 1:4900 N CUMBERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NORRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60706-2916
Mailing Address - Country:US
Mailing Address - Phone:708-456-1600
Mailing Address - Fax:708-456-2809
Practice Address - Street 1:4900 N CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:NORRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60706-2916
Practice Address - Country:US
Practice Address - Phone:708-456-1600
Practice Address - Fax:708-456-2809
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089056207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089056Medicaid
1619414OtherBCBS GROUP
ILL87964Medicare ID - Type Unspecified
216966004 EP/DPMedicare PIN
IL036089056Medicaid