Healthcare Provider Details

I. General information

NPI: 1669344610
Provider Name (Legal Business Name): IURII PADYNICH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 4832
BUFFALO GROVE IL
60089-4832
US

IV. Provider business mailing address

PO BOX 4832
BUFFALO GROVE IL
60089-4832
US

V. Phone/Fax

Practice location:
  • Phone: 847-722-3559
  • Fax: 847-415-2803
Mailing address:
  • Phone: 847-722-3559
  • Fax: 847-415-2803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number238.000841
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: