Individual
EVAN TKACZYK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2322 W PETERSON AVE., CHICAGO, IL 60659-3120
(800) 325-1812
Mailing address
87 S 2ND AVE, LOMBARD, IL 60148
(630) 408-6687
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
04/20/2020
Last updated
01/31/2021
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