Healthcare Provider Details

I. General information

NPI: 1447009675
Provider Name (Legal Business Name): CARINA PATRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

IV. Provider business mailing address

9650 GROSS POINT RD STE 2900
SKOKIE IL
60076-5006
US

V. Phone/Fax

Practice location:
  • Phone: 847-982-3171
  • Fax:
Mailing address:
  • Phone: 847-677-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085010579
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number085010579
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: