Provider Demographics
NPI:1255373866
Name:NOWOBILSKA, ANNA (MD)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
Last Name:NOWOBILSKA
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 1:5257 S CICERO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-4915
Mailing Address - Country:US
Mailing Address - Phone:773-735-8038
Mailing Address - Fax:888-839-6109
Practice Address - Street 1:5257 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-4915
Practice Address - Country:US
Practice Address - Phone:773-735-8038
Practice Address - Fax:888-839-6109
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036070270207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036070270Medicaid
IL036070270Medicaid
ILE68373Medicare UPIN