Healthcare Provider Details

I. General information

NPI: 1295299600
Provider Name (Legal Business Name): ALLISON RAGINS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2019
Last Update Date: 01/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 N OAK PARK AVE
CHICAGO IL
60707-3351
US

IV. Provider business mailing address

2211 N OAK PARK AVE
CHICAGO IL
60707-3351
US

V. Phone/Fax

Practice location:
  • Phone: 773-664-5400
  • Fax: 773-385-5488
Mailing address:
  • Phone: 773-664-5400
  • Fax: 773-385-5488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085006793
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: