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NPI Code Detail

MEDICARE: DEVON ANDERSON PA-C

MEDICARE: DEVON ANDERSON 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
1363AS0400XSurgical Physician Assistant085009551IL
2363A00000XPhysician Assistant085009551IL
3363A00000XPhysician Assistant101927IA

General Provider Information

NPI Number : 1942837976
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEVON ANDERSON PA-C
Provider Business Mailing Address
First Line : 9600 GROSS POINT RD STE 1200
Second Line :
City : SKOKIE
State : IL
Zip : 60076-1214
Country : US
Telephone Number : 847-866-7846
Fax Number :
Provider Business Practice Location Address
First Line : 9600 GROSS POINT RD STE 1200
Second Line :
City : SKOKIE
State : IL
Zip : 60076-1214
Country : US
Telephone Number : 847-866-7846
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2020
Last Update Date : 03/20/2026

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Directions to “ DEVON ANDERSON PA-C” Practice Location

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