Provider Demographics
NPI:1922176841
Name:MISN INC
Entity Type:Organization
Organization Name:MISN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MALGORZATA
Authorized Official - Middle Name:
Authorized Official - Last Name:SYPIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-205-2555
Mailing Address - Street 1:5012 W. LAWRENCE 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:773-205-2555
Mailing Address - Fax:773-205-4439
Practice Address - Street 1:5012 W.LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630
Practice Address - Country:US
Practice Address - Phone:773-205-2555
Practice Address - Fax:773-205-4439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098339207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01632867OtherBCBS
IL036098339Medicaid
IL036098339Medicaid
IL01632867OtherBCBS