Healthcare Provider Details

I. General information

NPI: 1770497315
Provider Name (Legal Business Name): MICHAL GRACZYK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 HIGHLAND AVE
BERWYN IL
60402-6273
US

IV. Provider business mailing address

1432 HIGHLAND AVE
BERWYN IL
60402-6273
US

V. Phone/Fax

Practice location:
  • Phone: 630-890-8426
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number041434056
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: