Healthcare Provider Details

I. General information

NPI: 1245568393
Provider Name (Legal Business Name): KATHRYN SWEDLUND PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN GEORGE

II. Dates (important events)

Enumeration Date: 12/01/2009
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 W POLK ST
CHICAGO IL
60612-3723
US

IV. Provider business mailing address

700 COMMERCE DR STE 500
OAK BROOK IL
60523-8736
US

V. Phone/Fax

Practice location:
  • Phone: 630-864-0065
  • Fax:
Mailing address:
  • Phone: 630-205-6612
  • Fax: 847-698-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085.005213
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: