Healthcare Provider Details

I. General information

NPI: 1942525910
Provider Name (Legal Business Name): KIMBERLY A. BIALEK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2010
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVE DR
ALGONQUIN IL
60102-6333
US

IV. Provider business mailing address

3800 RESERVE DR
ALGONQUIN IL
60102-6333
US

V. Phone/Fax

Practice location:
  • Phone: 847-370-1874
  • Fax:
Mailing address:
  • Phone: 847-370-1874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085003711
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085003711
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085-003711
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: