Provider Demographics
NPI:1447350558
Name:CZOSEK, MEGAN ELIZABETH (PA-C)
Entity type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:CZOSEK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:525 W HAWTHORNE PL APT 407
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-2901
Mailing Address - Country:US
Mailing Address - Phone:847-323-8150
Mailing Address - Fax:
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:PROF. BLDG. 3, SUITE 774
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-738-3732
Practice Address - Fax:312-738-9763
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL85002062363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ16040Medicare UPIN