Healthcare Provider Details

I. General information

NPI: 1720952765
Provider Name (Legal Business Name): LAUREN KUZNICKI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 ORLAND SQUARE DR STE 101
ORLAND PARK IL
60462-6522
US

IV. Provider business mailing address

1358 N ARTESIAN AVE APT 3F
CHICAGO IL
60622-3120
US

V. Phone/Fax

Practice location:
  • Phone: 708-726-6944
  • Fax:
Mailing address:
  • Phone: 248-921-2837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: