Provider Demographics
NPI:1871762898
Name:OWIKOTI, CLAUDE P (PA)
Entity type:Individual
Prefix:MR
First Name:CLAUDE
Middle Name:P
Last Name:OWIKOTI
Suffix:
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 1:1696 WILLIAM DR
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-1464
Mailing Address - Country:US
Mailing Address - Phone:815-609-3804
Mailing Address - Fax:
Practice Address - Street 1:23813 E 3200 NORTH RD
Practice Address - Street 2:
Practice Address - City:DWIGHT
Practice Address - State:IL
Practice Address - Zip Code:60420-8144
Practice Address - Country:US
Practice Address - Phone:815-584-2806
Practice Address - Fax:815-584-3227
Is Sole Proprietor?:No
Enumeration Date:2008-02-24
Last Update Date:2008-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL85003157363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant