Provider Demographics
NPI:1174522379
Name:BRYNICZKA, GREGORY C (DPM)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:C
Last Name:BRYNICZKA
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 1:705 WARRENVILLE RD
Mailing Address - Street 2:UNIT B
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-6379
Mailing Address - Country:US
Mailing Address - Phone:630-668-8277
Mailing Address - Fax:630-668-3358
Practice Address - Street 1:705 WARRENVILLE RD
Practice Address - Street 2:UNIT B
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-6379
Practice Address - Country:US
Practice Address - Phone:630-668-8277
Practice Address - Fax:630-668-3358
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL162778213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL240470Medicare PIN
ILT35526Medicare UPIN