Healthcare Provider Details

I. General information

NPI: 1770107195
Provider Name (Legal Business Name): DANIEL CZARNOWSKI MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2020
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 W 68TH ST
CHICAGO IL
60629-1813
US

IV. Provider business mailing address

26460 NETWORK PL
CHICAGO IL
60673-3370
US

V. Phone/Fax

Practice location:
  • Phone: 773-884-9000
  • Fax:
Mailing address:
  • Phone: 773-257-2820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085008845
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: