Healthcare Provider Details

I. General information

NPI: 1417086679
Provider Name (Legal Business Name): JAIMIE C. REILLY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 S WILKE RD STE 110
ARLINGTON HEIGHTS IL
60005-1524
US

IV. Provider business mailing address

1200 W STATE ST
ROCKFORD IL
61102-2112
US

V. Phone/Fax

Practice location:
  • Phone: 847-797-4888
  • Fax: 847-739-0978
Mailing address:
  • Phone: 815-490-1600
  • Fax: 815-490-1845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085-002904
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: