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NPI Code Detail

MEDICARE: COURTENAY CHAREICE SPEARS PA-S

MEDICARE: COURTENAY CHAREICE SPEARS PA-S
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1558247163
Entity Type Code : Individual
Provider Name (Legal Business Name) : COURTENAY CHAREICE SPEARS PA-S
Provider Business Mailing Address
First Line : 5741 ERIE AVE
Second Line :
City : HAMMOND
State : IN
Zip : 46320-2307
Country : US
Telephone Number : 312-863-0352
Fax Number :
Provider Business Practice Location Address
First Line : 2718 W ROSCOE ST
Second Line :
City : CHICAGO
State : IL
Zip : 60618-5910
Country : US
Telephone Number : 773-961-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2025
Last Update Date : 10/01/2025

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Directions to “ COURTENAY CHAREICE SPEARS PA-S” Practice Location

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