Provider Demographics
NPI:1053365577
Name:SCIGACZ, BOZENA EWA (MD)
Entity type:Individual
Prefix:
First Name:BOZENA
Middle Name:EWA
Last Name:SCIGACZ
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 1:28 W LAKE ST
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-2709
Mailing Address - Country:US
Mailing Address - Phone:630-458-0688
Mailing Address - Fax:630-458-0698
Practice Address - Street 1:28 W LAKE ST
Practice Address - Street 2:SUITE # 2
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-2709
Practice Address - Country:US
Practice Address - Phone:630-458-0688
Practice Address - Fax:630-458-0698
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036107066207R00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL213586OtherMEDICARE GROUP PTAN
ILK27755OtherMEDICARE PTAN
ILP00313447OtherRAILROAD MEDICARE