Basic Information
| Provider Information | |||||||||
| NPI: | 1871674267 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PODGORSKA | ||||||||
| FirstName: | HELENA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4900 N CUMBERLAND AVE | ||||||||
| Address2: | |||||||||
| City: | NORRIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 607062916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084561600 | ||||||||
| FaxNumber: | 7084562809 | ||||||||
| Practice Location | |||||||||
| Address1: | 4900 N CUMBERLAND AVE | ||||||||
| Address2: | |||||||||
| City: | NORRIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 607062916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084561600 | ||||||||
| FaxNumber: | 7084562809 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 04/06/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036089056 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036089056 | 05 | IL | MEDICAID | 1619414 | 01 | BCBS GROUP | OTHER |