Healthcare Provider Details

I. General information

NPI: 1942537915
Provider Name (Legal Business Name): COLLEEN JOYCE VOLZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLLEEN ELSEN

II. Dates (important events)

Enumeration Date: 11/11/2009
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W 95TH ST STE 413
OAK LAWN IL
60453-3647
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 708-346-4055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085-003640
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085-003640
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: