| Fox Valley Adult And Pediatric Medicine Pc | |
|
2020 Dean St. Ste G St. Charles IL 60174-1665 | |
| (630) 513-0298 | |
| Not Available |
| Full Name | Fox Valley Adult And Pediatric Medicine Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2020 Dean St. Ste G, St. Charles, Illinois |
| Authorized Official Name and Position | Zbigniew Marian Ciechanowski (CEO) |
| Authorized Official Contact | 6305130298 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fox Valley Adult And Pediatric Medicine Pc 2020 Dean St. Ste G St. Charles IL 60174-1665 Ph: (630) 513-0298 | Fox Valley Adult And Pediatric Medicine Pc 2020 Dean St. Ste G St. Charles IL 60174-1665 Ph: (630) 513-0298 |
| NPI Number | 1558546952 |
|---|---|
| Provider Enumeration Date | 01/03/2008 |
| Last Update Date | 03/31/2008 |
| Medicare PECOS PAC ID | 4082685912 |
|---|---|
| Medicare Enrollment ID | O20040804000812 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558546952 | NPI | - | NPPES |
| 04532182 | Other | IL | BLUE CROSS BLUE SHIELD IL |
| E94586 | Other | UPIN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (Illinois) | Primary |
| 208000000X | Pediatrics | (Illinois) | Secondary |
| Provider Name | Zbigniew Ciechanowski |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467452573 PECOS PAC ID: 3476452681 Enrollment ID: I20040806001271 |
Leroy Oaks Family Medicine, P.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2435 Dean Street, Suite C, St. Charles, IL 60175 Phone: 630-377-8880 Fax: 630-485-5129 |