Basic Information
| Provider Information | |||||||||
| NPI: | 1558396085 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STRACZYNSKI | ||||||||
| FirstName: | EDYTA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1220 HOBSON ROAD | ||||||||
| Address2: | STE 104 | ||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605408137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304161950 | ||||||||
| FaxNumber: | 6306465610 | ||||||||
| Practice Location | |||||||||
| Address1: | 1220 HOBSON ROAD | ||||||||
| Address2: | STE 104 | ||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605408137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304161950 | ||||||||
| FaxNumber: | 6306465610 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 12/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036-115300 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 15583960852 | 05 | IL | MEDICAID | 2221820 | 01 | IL | BCBS | OTHER |