Healthcare Provider Details

I. General information

NPI: 1386995322
Provider Name (Legal Business Name): EMILY KATE SANDOWSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY KATE MIRAL PA-C

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 W 68TH ST
CHICAGO IL
60629-1813
US

IV. Provider business mailing address

3236 ARTHUR AVE
BROOKFIELD IL
60513-1222
US

V. Phone/Fax

Practice location:
  • Phone: 773-884-9000
  • Fax:
Mailing address:
  • Phone: 630-440-4108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085-004486
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: