Provider Demographics
NPI:1518767672
Name:RADZIK, MIROSLAWA (APRN)
Entity type:Individual
Prefix:
First Name:MIROSLAWA
Middle Name:
Last Name:RADZIK
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 LEE ST STE 150
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-4554
Mailing Address - Country:US
Mailing Address - Phone:224-985-1214
Mailing Address - Fax:224-285-1214
Practice Address - Street 1:701 LEE ST STE 150
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4554
Practice Address - Country:US
Practice Address - Phone:224-985-1214
Practice Address - Fax:224-285-1214
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209031625363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily