Healthcare Provider Details

I. General information

NPI: 1548718216
Provider Name (Legal Business Name): KRZYSZTOF GARBARZ FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 W LAKE ST
CHICAGO IL
60644-2342
US

IV. Provider business mailing address

2020 E WAVERLY LN
ARLINGTON HEIGHTS IL
60004-3454
US

V. Phone/Fax

Practice location:
  • Phone: 773-378-3347
  • Fax: 773-378-4028
Mailing address:
  • Phone: 847-385-8813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209014680
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: