Healthcare Provider Details

I. General information

NPI: 1538733647
Provider Name (Legal Business Name): RILEY IRENE SYKES PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2021
Last Update Date: 03/13/2022
Certification Date: 03/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N WESTMORELAND RD FL B3
LAKE FOREST IL
60045-1658
US

IV. Provider business mailing address

1000 N WESTMORELAND RD FL B3
LAKE FOREST IL
60045-1658
US

V. Phone/Fax

Practice location:
  • Phone: 847-535-8500
  • Fax: 847-535-8499
Mailing address:
  • Phone: 847-535-8500
  • Fax: 847-535-8499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number085.008588
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: