Healthcare Provider Details

I. General information

NPI: 1205796729
Provider Name (Legal Business Name): ABBIE BRINK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST STE 358
CHICAGO IL
60612-3849
US

IV. Provider business mailing address

1725 W HARRISON ST STE 358
CHICAGO IL
60612-3849
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5020
  • Fax:
Mailing address:
  • Phone: 312-942-5020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.012056
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: