Healthcare Provider Details

I. General information

NPI: 1811619729
Provider Name (Legal Business Name): TESSA ELLEN BUZZETTI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7447 W TALCOTT AVE STE 507D
CHICAGO IL
60631-3716
US

IV. Provider business mailing address

7447 W TALCOTT AVE STE 507D
CHICAGO IL
60631-3716
US

V. Phone/Fax

Practice location:
  • Phone: 847-472-1992
  • Fax:
Mailing address:
  • Phone: 847-472-1992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085009631
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: