MEDICARE: MS. LISA ANN CHARLES FIELDS PHD, 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	363A00000X	Physician Assistant	085.001395	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952313207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA ANN CHARLES FIELDS PHD, PA-C

Provider Business Mailing Address
First Line	:	1809 SHERIDAN RD
Second Line	:
City	:	NORTH CHICAGO
State	:	IL
Zip	:	60064-2235
Country	:	US
Telephone Number	:	847-785-0611
Fax Number	:	847-785-0612

Provider Business Practice Location Address
First Line	:	1809 SHERIDAN RD
Second Line	:
City	:	NORTH CHICAGO
State	:	IL
Zip	:	60064-2235
Country	:	US
Telephone Number	:	847-785-0611
Fax Number	:	847-785-0612

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	11/27/2017

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