Individual
DR. TERESA A. WANCZYK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
3414 W PETERSON AVE, STE. D, CHICAGO, IL 60659-3452
(773) 271-2900
(773) 267-6113
Mailing address
6234 N ALBANY AVE, CHICAGO, IL 60659-1402
(773) 271-2900
(773) 267-6113
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
036-065883
IL
208000000X
Pediatrics Physician
036-065883
IL
208D00000X
General Practice Physician
Primary
036-065883
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036065883
—
IL
Enumeration date
09/21/2006
Last updated
06/25/2020
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