Healthcare Provider Details

I. General information

NPI: 1679197644
Provider Name (Legal Business Name): COREY CZARNECKI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3963 US HIGHWAY 34
OSWEGO IL
60543-8950
US

IV. Provider business mailing address

3963 US HIGHWAY 34
OSWEGO IL
60543-8950
US

V. Phone/Fax

Practice location:
  • Phone: 630-551-3338
  • Fax: 949-862-3678
Mailing address:
  • Phone: 630-551-3338
  • Fax: 949-862-3678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016006018
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number135.001103
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: