Basic Information
| Provider Information | |||||||||
| NPI: | 1215135371 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BORONIEC | ||||||||
| FirstName: | JILLIAN | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2835 N SHEFFIELD AVE | ||||||||
| Address2: | STE 104 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606575081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7734723704 | ||||||||
| FaxNumber: | 3125633170 | ||||||||
| Practice Location | |||||||||
| Address1: | 2835 N SHEFFIELD AVE | ||||||||
| Address2: | STE 104 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606575081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7734723704 | ||||||||
| FaxNumber: | 3125633170 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2007 | ||||||||
| LastUpdateDate: | 01/22/2014 | ||||||||
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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 | 036125235 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | A118443 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.