Provider Demographics
NPI:1750363222
Name:LASTOWIECKA, MONIKA (MD)
Entity type:Individual
Prefix:
First Name:MONIKA
Middle Name:
Last Name:LASTOWIECKA
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 1:1439 W SCHAUMBURG RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-4051
Mailing Address - Country:US
Mailing Address - Phone:847-895-0440
Mailing Address - Fax:
Practice Address - Street 1:2500 W HIGGINS RD,
Practice Address - Street 2:SUITE 640
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169
Practice Address - Country:US
Practice Address - Phone:847-895-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2019-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-095193207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G64725Medicare UPIN