Healthcare Provider Details

I. General information

NPI: 1386404135
Provider Name (Legal Business Name): MICHAELA GRACE TWOREK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 N RANDALL RD STE 110
ELGIN IL
60123-7900
US

IV. Provider business mailing address

1750 N RANDALL RD STE 110
ELGIN IL
60123-7900
US

V. Phone/Fax

Practice location:
  • Phone: 224-629-4525
  • Fax:
Mailing address:
  • Phone: 224-629-4525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.010799
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: