Healthcare Provider Details

I. General information

NPI: 1033915848
Provider Name (Legal Business Name): ALYSEE GIRAUD-CARRIER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2025
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S MAPLE AVE
OAK PARK IL
60304-1022
US

IV. Provider business mailing address

520 S MAPLE AVE
OAK PARK IL
60304-1022
US

V. Phone/Fax

Practice location:
  • Phone: 708-660-0600
  • Fax:
Mailing address:
  • Phone: 708-660-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085-011065
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: