Healthcare Provider Details

I. General information

NPI: 1306026935
Provider Name (Legal Business Name): SARA K ZIDLICKY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2007
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 SPRINGFIELD DR SUITE 290
BLOOMINGDALE IL
60108-2214
US

IV. Provider business mailing address

290 SPRINGFIELD DR SUITE 290
BLOOMINGDALE IL
60108-2214
US

V. Phone/Fax

Practice location:
  • Phone: 630-893-9660
  • Fax: 630-893-9668
Mailing address:
  • Phone: 630-893-9660
  • Fax: 630-893-9668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085003137
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: