Healthcare Provider Details

I. General information

NPI: 1467520809
Provider Name (Legal Business Name): DONALD VINCENT WOZNICA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 S WESTERN AVE
CHICAGO IL
60608-3837
US

IV. Provider business mailing address

711 S ELMWOOD AVE
OAK PARK IL
60304-1414
US

V. Phone/Fax

Practice location:
  • Phone: 773-254-1400
  • Fax:
Mailing address:
  • Phone: 708-383-8619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036 059741
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: