Provider Demographics
NPI:1881969806
Name:OSMIALOWSKI, JAROSLAW JAN (DN)
Entity type:Individual
Prefix:DR
First Name:JAROSLAW
Middle Name:JAN
Last Name:OSMIALOWSKI
Suffix:
Gender:M
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 W NORTH AVE
Mailing Address - Street 2:UNIT 2E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60707-4334
Mailing Address - Country:US
Mailing Address - Phone:773-800-1629
Mailing Address - Fax:773-340-1629
Practice Address - Street 1:7000 W NORTH AVE
Practice Address - Street 2:UNIT 2E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-4334
Practice Address - Country:US
Practice Address - Phone:773-800-1629
Practice Address - Fax:773-340-1629
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL181000372172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172P00000XOther Service ProvidersNaprapath