Healthcare Provider Details

I. General information

NPI: 1023099256
Provider Name (Legal Business Name): JARED ANDERSEN WOJNICKI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2005
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 S VERMONT ST STE C
PALATINE IL
60067-6968
US

IV. Provider business mailing address

6601 COLLEGE BLVD STE 120
OVERLAND PARK KS
66211-1504
US

V. Phone/Fax

Practice location:
  • Phone: 913-359-6001
  • Fax: 913-359-5552
Mailing address:
  • Phone: 913-359-6001
  • Fax: 913-359-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A8952
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.126628
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: