Healthcare Provider Details

I. General information

NPI: 1851421820
Provider Name (Legal Business Name): MARY KATHERYN AUKSTIK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 05/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 N OAK PARK AVE
CHICAGO IL
60707
US

IV. Provider business mailing address

2211 N OAK PARK AVE
CHICAGO IL
60707-3351
US

V. Phone/Fax

Practice location:
  • Phone: 773-622-5400
  • Fax:
Mailing address:
  • Phone: 773-622-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085003587
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number085003587
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070014405
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: