Healthcare Provider Details

I. General information

NPI: 1407551153
Provider Name (Legal Business Name): TOREE ELIZEBETH CURTIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 MAPLE AVE
BLUE ISLAND IL
60406-2318
US

IV. Provider business mailing address

882 WILSHIRE LN
CRETE IL
60417-1974
US

V. Phone/Fax

Practice location:
  • Phone: 708-385-6100
  • Fax:
Mailing address:
  • Phone: 217-781-2331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.009679
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number085.009679
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: