Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 016-005396 | IL |
NPI | 1104065291 |
---|---|
Provider Name | Dr. Adam William Bryniczka |
First Address | Wheaton, IL 60189-6379 |
Second Address | Wheaton, IL 60189-6379 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2009 |
Last Update Date | 08/10/2009 |