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General NPI Number Information
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NPI Number | 1467520809
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Entity Type | Individual
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Provider Name | DONALD VINCENT WOZNICA MD
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Gender | Male
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Dates
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Enumeration Date | 12/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2355 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60608-3837
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Country | US
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Telephone | 773-254-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 711 S ELMWOOD AVE
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City | OAK PARK
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State | IL
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Zip | 60304-1414
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Country | US
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Telephone | 708-383-8619
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036 059741
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License Number State | IL
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