Basic Information
| Provider Information | |||||||||
| NPI: | 1962763276 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PLUZYCZKA | ||||||||
| FirstName: | AGATA | ||||||||
| MiddleName: | NATALIA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 REMINGTON BLVD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604404707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309142468 | ||||||||
| FaxNumber: | 6309142469 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 AUSTIN ST | ||||||||
| Address2: | WEST TOWER, SUITE 505 | ||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 602023439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477331495 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2012 | ||||||||
| LastUpdateDate: | 12/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036136936 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.