Healthcare Provider Details

I. General information

NPI: 1346238466
Provider Name (Legal Business Name): TERESA A ZEPKA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15300 WEST AVE STE 210
ORLAND PARK IL
60462-4686
US

IV. Provider business mailing address

15300 WEST AVE STE 210
ORLAND PARK IL
60462-4686
US

V. Phone/Fax

Practice location:
  • Phone: 708-226-2870
  • Fax: 708-226-2390
Mailing address:
  • Phone: 708-226-2870
  • Fax: 708-226-2390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085010508
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA056282
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: