MEDICARE: ANDREA PARKS 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
1	363AS0400X	Surgical Physician Assistant	1906-23	WI

General Provider Information

NPI Number	:	1437150471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA PARKS PA-C

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE
Second Line	:	EVANSTON HOSPITAL DIVISION OF NEUROSURGERY
City	:	EVANSTON
State	:	IL
Zip	:	60201
Country	:	US
Telephone Number	:	847-570-1440
Fax Number	:	847-570-1442

Provider Business Practice Location Address
First Line	:	2650 RIDGE AVE
Second Line	:	DIVISION OF NEUROSURGERY
City	:	EVANSTON
State	:	IL
Zip	:	60201-1718
Country	:	US
Telephone Number	:	847-570-1440
Fax Number	:	847-570-1442

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	02/26/2008

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