Healthcare Provider Details

I. General information

NPI: 1275200149
Provider Name (Legal Business Name): DAVID PROTAZIUK FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2021
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date: 03/09/2022
Reactivation Date: 04/18/2022

III. Provider practice location address

7501 LEMONT RD STE 345D
WOODRIDGE IL
60517-2677
US

IV. Provider business mailing address

7501 LEMONT RD STE 345D
WOODRIDGE IL
60517-2677
US

V. Phone/Fax

Practice location:
  • Phone: 708-244-2627
  • Fax:
Mailing address:
  • Phone: 708-244-2627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277002570
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: