MEDICARE: ALLISON PAIGE BLICHARZ 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
1	363A00000X	Physician Assistant	085012129	IL

General Provider Information

NPI Number	:	1982442315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON PAIGE BLICHARZ PA-S

Provider Business Mailing Address
First Line	:	420 NE GLEN OAK AVE
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61603-3106
Country	:	US
Telephone Number	:	309-655-4180
Fax Number	:	309-308-3948

Provider Business Practice Location Address
First Line	:	420 NE GLEN OAK AVE
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61603-3106
Country	:	US
Telephone Number	:	309-655-4180
Fax Number	:	309-308-3948

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

Provider Enumeration Date	:	07/18/2024
Last Update Date	:	03/03/2026

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