Healthcare Provider Details

I. General information

NPI: 1669337820
Provider Name (Legal Business Name): ALEXANDRA ROSARIA OETINGER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 PARK AVE W
HIGHLAND PARK IL
60035-2433
US

IV. Provider business mailing address

25471 N COUNTRYSIDE CT
LAKE BARRINGTON IL
60010-7031
US

V. Phone/Fax

Practice location:
  • Phone: 847-432-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: