Healthcare Provider Details

I. General information

NPI: 1194486886
Provider Name (Legal Business Name): EMILY DESBIENS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST STE 818
CHICAGO IL
60612-3895
US

IV. Provider business mailing address

1725 W HARRISON ST STE 818
CHICAGO IL
60612-3895
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5500
  • Fax:
Mailing address:
  • Phone: 312-942-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.011655
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: