Provider Demographics
NPI:1558396085
Name:STRACZYNSKI, EDYTA (MD)
Entity Type:Individual
Prefix:
First Name:EDYTA
Middle Name:
Last Name:STRACZYNSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 HOBSON ROAD
Mailing Address - Street 2:STE 104
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-8137
Mailing Address - Country:US
Mailing Address - Phone:630-416-1950
Mailing Address - Fax:630-646-5610
Practice Address - Street 1:1220 HOBSON ROAD
Practice Address - Street 2:STE 104
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-8137
Practice Address - Country:US
Practice Address - Phone:630-416-1950
Practice Address - Fax:630-646-5610
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-115300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL15583960852Medicaid
IL2221820OtherBCBS
IL2221820OtherBCBS
ILR01255Medicare PIN