| Organization Name: | NORTHWEST PODIATRY CENTER |
| NPI Number: | 1063690741 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GREGORY C BRYNICZKA (PRESIDENT) |
| Mailing Address: | 705 Warrenville Rd Unit B Wheaton |
| State: | IL US |
| Postal Code: | 601896379 |
| Phone Number: | 6306688277 |
| Fax Number: | 6306683358 |
| NPI Enumeration Date: | 02/05/2008 |
| NPI Last Update Date: | 09/19/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | 16-2778 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |