Organization
TERESA A. WANCZYK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERESA A GROSVENOR M.S.,D.O. (PHYSICIAN)
(773) 271-2900
Entity
Organization
Contact information
Practice address
3420 W PETERSON AVE, SUITE 6, CHICAGO, IL 60659-3418
(773) 271-2900
(773) 267-6113
Mailing address
3420 W PETERSON AVE, SUITE 6, CHICAGO, IL 60659-3418
(773) 271-2900
(773) 267-6113
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
Primary
036065883
IL
Other
Enumeration date
12/27/2010
Last updated
01/05/2011
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