Provider Demographics
NPI:1457985350
Name:RADOWSKA, KINGA (DO)
Entity type:Individual
Prefix:DR
First Name:KINGA
Middle Name:
Last Name:RADOWSKA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 N GARY AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3055
Mailing Address - Country:US
Mailing Address - Phone:630-614-4100
Mailing Address - Fax:630-614-4148
Practice Address - Street 1:2001 N GARY AVE STE 110
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-3055
Practice Address - Country:US
Practice Address - Phone:630-614-4100
Practice Address - Fax:630-614-4148
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL125.078772207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program