Provider Demographics
NPI:1679197644
Name:CZARNECKI, COREY (DPM)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:
Last Name:CZARNECKI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6039 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-5150
Mailing Address - Country:US
Mailing Address - Phone:773-745-1919
Mailing Address - Fax:773-745-1998
Practice Address - Street 1:6039 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-5150
Practice Address - Country:US
Practice Address - Phone:773-745-1919
Practice Address - Fax:773-745-1998
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL135.001103213EP1101X, 213EP1101X
IL016006018213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist