Provider Demographics
NPI:1447260369
Name:WEST, PAUL E III (PA)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:WEST
Suffix:III
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 ABERDEEN RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-9712
Mailing Address - Country:US
Mailing Address - Phone:815-806-0340
Mailing Address - Fax:815-806-0341
Practice Address - Street 1:1900 W POLK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3723
Practice Address - Country:US
Practice Address - Phone:312-864-0917
Practice Address - Fax:312-864-9242
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000855A146D00000X, 363AS0400X
IL085-000949363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant