Provider Demographics
NPI:1295937662
Name:JACKOWSKI, MARIOLA (MD)
Entity type:Individual
Prefix:
First Name:MARIOLA
Middle Name:
Last Name:JACKOWSKI
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 1:657 E. GOLF RD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-4968
Mailing Address - Country:US
Mailing Address - Phone:224-404-6000
Mailing Address - Fax:773-774-0019
Practice Address - Street 1:657 E. GOLF RD
Practice Address - Street 2:SUITE 309
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4968
Practice Address - Country:US
Practice Address - Phone:224-404-6000
Practice Address - Fax:773-774-0019
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.118003208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics