Healthcare Provider Details

I. General information

NPI: 1689393217
Provider Name (Legal Business Name): AMY GOLASZEWSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10720 165TH ST
ORLAND PARK IL
60467-8714
US

IV. Provider business mailing address

10720 165TH ST
ORLAND PARK IL
60467-8714
US

V. Phone/Fax

Practice location:
  • Phone: 708-460-7890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085009338
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: