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NPI Code Detail

MEDICARE: MRS. KELLY STRAZZANTE RD, PA-C

MEDICARE: MRS. KELLY STRAZZANTE RD, PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered Dietitian86056816IN
2363A00000XPhysician Assistant085010447IL
3363A00000XPhysician Assistant

General Provider Information

NPI Number : 1023462488
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLY STRAZZANTE RD, PA-C
Provider Business Mailing Address
First Line : 150 HARVESTER DR STE 300
Second Line :
City : BURR RIDGE
State : IL
Zip : 60527-5965
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10855 VIRGINIA ST
Second Line :
City : CROWN POINT
State : IN
Zip : 46307-0210
Country : US
Telephone Number : 219-407-5500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/21/2016
Last Update Date : 07/01/2025

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