Healthcare Provider Details

I. General information

NPI: 1144422635
Provider Name (Legal Business Name): LONA SUZANNE ERNST RIZKALLAH MS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 WAUKEGAN RD STE 100
BANNOCKBURN IL
60015-1885
US

IV. Provider business mailing address

2151 WAUKEGAN RD STE 100
BANNOCKBURN IL
60015-1885
US

V. Phone/Fax

Practice location:
  • Phone: 847-444-5300
  • Fax: 847-267-1429
Mailing address:
  • Phone: 847-444-5300
  • Fax: 847-267-1429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number085-002272
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: