Provider Demographics
NPI:1447008255
Name:NAMATAME, LISA ANGELA (PA-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANGELA
Last Name:NAMATAME
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3154 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4437
Mailing Address - Country:US
Mailing Address - Phone:773-751-7800
Mailing Address - Fax:
Practice Address - Street 1:3154 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4437
Practice Address - Country:US
Practice Address - Phone:773-751-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085011393363AM0700X
IL085363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical