Provider Demographics
NPI:1073064960
Name:JANCZYK, DARYL
Entity Type:Individual
Prefix:
First Name:DARYL
Middle Name:
Last Name:JANCZYK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SCHELTER RD STE 30
Mailing Address - Street 2:
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069-3657
Mailing Address - Country:US
Mailing Address - Phone:847-821-0074
Mailing Address - Fax:
Practice Address - Street 1:103 SCHELTER RD STE 30
Practice Address - Street 2:
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-3657
Practice Address - Country:US
Practice Address - Phone:847-821-0074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305138-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health