Healthcare Provider Details

I. General information

NPI: 1043955818
Provider Name (Legal Business Name): YESENIA GUZMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 05/23/2024
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W LAKE COOK RD STE 120
BUFFALO GROVE IL
60089-2085
US

IV. Provider business mailing address

600 W LAKE COOK RD STE 120
BUFFALO GROVE IL
60089-2085
US

V. Phone/Fax

Practice location:
  • Phone: 847-808-8884
  • Fax: 847-808-8890
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085009171
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: