Healthcare Provider Details

I. General information

NPI: 1760993711
Provider Name (Legal Business Name): ELIZABETH WOJTOWICZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9570 W 159TH ST
ORLAND PARK IL
60467-5504
US

IV. Provider business mailing address

14670 MAPLECREEK DR
ORLAND PARK IL
60467-7200
US

V. Phone/Fax

Practice location:
  • Phone: 708-675-7070
  • Fax:
Mailing address:
  • Phone: 708-275-5750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085006420
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085006420
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: