Healthcare Provider Details

I. General information

NPI: 1487054771
Provider Name (Legal Business Name): CHAD B. ANDERSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2014
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

IV. Provider business mailing address

2180 PFINGSTEN RD
GLENVIEW IL
60026-1339
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-2040
  • Fax:
Mailing address:
  • Phone: 847-866-7846
  • Fax: 224-251-5100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number085003532
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: