Healthcare Provider Details

I. General information

NPI: 1295051670
Provider Name (Legal Business Name): ALISON JOY HORNYAK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISON JOY GIBSON D.O.

II. Dates (important events)

Enumeration Date: 04/11/2010
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W 95TH ST STE 1200H
OAK LAWN IL
60453-2654
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-5643
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number14196
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: