Healthcare Provider Details

I. General information

NPI: 1245163591
Provider Name (Legal Business Name): NATALIA GLOWACKA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7447 W TALCOTT AVE
CHICAGO IL
60631-3745
US

IV. Provider business mailing address

238 E IRVING PARK RD UNIT 306
WOOD DALE IL
60191-3008
US

V. Phone/Fax

Practice location:
  • Phone: 248-278-0970
  • Fax:
Mailing address:
  • Phone: 773-551-5827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.012126
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: