Healthcare Provider Details

I. General information

NPI: 1164573374
Provider Name (Legal Business Name): MARGARET SORRELLS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4309 W MEDICAL CENTER DR STE B300
MCHENRY IL
60050
US

IV. Provider business mailing address

4309 W MEDICAL CENTER DR STE B300
MCHENRY IL
60050-8440
US

V. Phone/Fax

Practice location:
  • Phone: 815-759-4224
  • Fax: 815-363-0136
Mailing address:
  • Phone: 815-759-4224
  • Fax: 815-363-0136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085-000756
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: