Healthcare Provider Details

I. General information

NPI: 1093378093
Provider Name (Legal Business Name): KALEE EMILY HARTMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1929 10TH AVE E
MILAN IL
61264-2953
US

IV. Provider business mailing address

1929 10TH AVE E
MILAN IL
61264-2953
US

V. Phone/Fax

Practice location:
  • Phone: 309-787-2600
  • Fax:
Mailing address:
  • Phone: 309-787-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085.007038
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: