Provider Demographics
NPI:1558831743
Name:PAWELCZYK, KRYSTYNA
Entity type:Individual
Prefix:
First Name:KRYSTYNA
Middle Name:
Last Name:PAWELCZYK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 E OLD WILLOW RD APT 208
Mailing Address - Street 2:
Mailing Address - City:PROSPECT HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60070-2124
Mailing Address - Country:US
Mailing Address - Phone:847-809-6629
Mailing Address - Fax:
Practice Address - Street 1:820 FOSTER ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3212
Practice Address - Country:US
Practice Address - Phone:847-492-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.006579208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation