Healthcare Provider Details

I. General information

NPI: 1982201638
Provider Name (Legal Business Name): LAURA GARCIA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 W 26TH ST
CHICAGO IL
60623-3824
US

IV. Provider business mailing address

3400 LAFAYETTE RD STE 200
INDIANAPOLIS IN
46222-1147
US

V. Phone/Fax

Practice location:
  • Phone: 773-542-5203
  • Fax:
Mailing address:
  • Phone: 317-291-7422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10004049A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number085.007794
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: