Healthcare Provider Details

I. General information

NPI: 1124660337
Provider Name (Legal Business Name): CLEMENTIE SINIGUR PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4390 66TH ST N
KENNETH CITY FL
33709-4920
US

IV. Provider business mailing address

60 ORLAND SQUARE DR STE 101
ORLAND PARK IL
60462-6522
US

V. Phone/Fax

Practice location:
  • Phone: 727-513-4100
  • Fax:
Mailing address:
  • Phone: 407-780-8876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.007356
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: