Provider Demographics
NPI:1922160365
Name:DZIOK, JOLANTA (MD)
Entity Type:Individual
Prefix:MRS
First Name:JOLANTA
Middle Name:
Last Name:DZIOK
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 1:11252 W ALEXANDRIA LN
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5934
Mailing Address - Country:US
Mailing Address - Phone:708-562-5132
Mailing Address - Fax:
Practice Address - Street 1:7447 W TALCOTT AVE
Practice Address - Street 2:SUTE 509
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3745
Practice Address - Country:US
Practice Address - Phone:773-792-2939
Practice Address - Fax:773-792-3214
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036055387208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21609426OtherBCBS PROVIDER NUMBER