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General NPI Number Information
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NPI Number | 1316030943
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Entity Type | Organization
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Legal Business Name | NORTHWEST PODIATRY CENTER, LTD
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 09/19/2008
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Provider Practice Location Address
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Address Line | 705 WARRENVILLE RD STE B
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City | WHEATON
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State | IL
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Zip | 60189-6379
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Country | US
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Telephone | 630-668-8277
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Fax | 630-668-3358
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Provider Business Mailing Address
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Address Line | 705 WARRENVILLE RD STE B
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City | WHEATON
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State | IL
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Zip | 60189-6379
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Country | US
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Telephone | 630-668-8277
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Fax | 630-668-3358
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Authorized Official
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Title or Position | OWNER
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Name | DR. GREGORY C. BRYNICZKA
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Credential | DPM
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Telephone | 630-668-8277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 162778
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License Number State | IL
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