Provider Demographics
NPI:1669783411
Name:WOZNICA, DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:WOZNICA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 LAKE STREET
Mailing Address - Street 2:600
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301
Mailing Address - Country:US
Mailing Address - Phone:708-848-7789
Mailing Address - Fax:855-779-1950
Practice Address - Street 1:715 LAKE ST STE 600
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1415
Practice Address - Country:US
Practice Address - Phone:708-848-7789
Practice Address - Fax:855-779-1950
Is Sole Proprietor?:No
Enumeration Date:2010-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN62524208100000X
CT54513208100000X
MS28513208100000X
IL0361430302081S0010X, 208100000X
CT054132081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine