Healthcare Provider Details

I. General information

NPI: 1619540762
Provider Name (Legal Business Name): DARIA LUCJA SZYMCZYK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2021
Last Update Date: 01/08/2022
Certification Date: 01/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 S MILWAUKEE AVE
LIBERTYVILLE IL
60048-3225
US

IV. Provider business mailing address

716 S MILWAUKEE AVE
LIBERTYVILLE IL
60048-3225
US

V. Phone/Fax

Practice location:
  • Phone: 847-362-1848
  • Fax: 847-362-3351
Mailing address:
  • Phone: 847-362-1848
  • Fax: 847-362-3351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: