Provider Demographics
NPI:1053406231
Name:MACHNICA, DOBROSLAWA BLANKA (MD)
Entity type:Individual
Prefix:
First Name:DOBROSLAWA
Middle Name:BLANKA
Last Name:MACHNICA
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 1:675 W NORTH AVE
Mailing Address - Street 2:STE 507
Mailing Address - City:MELROSE PK
Mailing Address - State:IL
Mailing Address - Zip Code:60160
Mailing Address - Country:US
Mailing Address - Phone:708-681-7685
Mailing Address - Fax:708-681-7326
Practice Address - Street 1:675 W NORTH AVE
Practice Address - Street 2:STE 567
Practice Address - City:MELROSE PK
Practice Address - State:IL
Practice Address - Zip Code:60160
Practice Address - Country:US
Practice Address - Phone:708-681-7685
Practice Address - Fax:708-681-7326
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1018481OtherAETNA
IL21623416OtherBCBS