Healthcare Provider Details

I. General information

NPI: 1508266776
Provider Name (Legal Business Name): MEREDITH JULIA FILS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEREDITH JULIA CAMPBELL PA-C

II. Dates (important events)

Enumeration Date: 08/25/2014
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6141 N CICERO AVE
CHICAGO IL
60646-4303
US

IV. Provider business mailing address

2740 W FOSTER AVE UNIT A
CHICAGO IL
60625-3500
US

V. Phone/Fax

Practice location:
  • Phone: 773-907-7750
  • Fax: 773-907-7760
Mailing address:
  • Phone: 773-878-8200
  • Fax: 773-293-8804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.005160
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: