Healthcare Provider Details

I. General information

NPI: 1447260369
Provider Name (Legal Business Name): PAUL E WEST III PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 W POLK ST
CHICAGO IL
60612-3723
US

IV. Provider business mailing address

527 ABERDEEN RD
FRANKFORT IL
60423-9712
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-0917
  • Fax: 312-864-9242
Mailing address:
  • Phone: 815-806-0340
  • Fax: 815-806-0341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number10000855A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number085-000949
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number10000855A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: