Healthcare Provider Details

I. General information

NPI: 1750611646
Provider Name (Legal Business Name): KARLIJN BURRIDGE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARLIJN UIJTERSCHOUT PA

II. Dates (important events)

Enumeration Date: 12/28/2009
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 QUAIL RIDGE DR
WESTMONT IL
60559-6145
US

IV. Provider business mailing address

308 HAWTHORNE BLVD
GLEN ELLYN IL
60137-4040
US

V. Phone/Fax

Practice location:
  • Phone: 630-986-2800
  • Fax: 630-986-2440
Mailing address:
  • Phone: 520-250-7135
  • Fax: 630-261-9335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085.007045
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA08041
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number4563
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.007045
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: