Provider Demographics
NPI:1659120111
Name:CUDZICH NOWAKOWSKI, MALGORZATA HELENA
Entity type:Individual
Prefix:
First Name:MALGORZATA
Middle Name:HELENA
Last Name:CUDZICH NOWAKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 W LAKE ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-4042
Mailing Address - Country:US
Mailing Address - Phone:630-229-5444
Mailing Address - Fax:708-615-7547
Practice Address - Street 1:1350 W LAKE ST UNIT 1
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-4042
Practice Address - Country:US
Practice Address - Phone:708-343-8512
Practice Address - Fax:708-343-8529
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209029723363LX0001X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology