Healthcare Provider Details

I. General information

NPI: 1235989302
Provider Name (Legal Business Name): ALEXANDRA CARNATHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E 51ST ST
CHICAGO IL
60615-2400
US

IV. Provider business mailing address

500 E 51ST ST
CHICAGO IL
60615-2400
US

V. Phone/Fax

Practice location:
  • Phone: 312-572-2000
  • Fax: 312-572-1763
Mailing address:
  • Phone: 330-550-5717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085-010715
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: