Healthcare Provider Details

I. General information

NPI: 1053768556
Provider Name (Legal Business Name): ANDREA LAUREN NAVRATIL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 N DEARBORN ST STE 100
CHICAGO IL
60654-4618
US

IV. Provider business mailing address

635 N DEARBORN ST STE 100
CHICAGO IL
60654-4618
US

V. Phone/Fax

Practice location:
  • Phone: 312-694-2273
  • Fax: 312-694-2129
Mailing address:
  • Phone: 312-694-2273
  • Fax: 312-694-2129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085005912
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: