Healthcare Provider Details

I. General information

NPI: 1588478713
Provider Name (Legal Business Name): PATRICIA DEBOSZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 CALUMET AVE STE E
MUNSTER IN
46321-2912
US

IV. Provider business mailing address

7916 W LAWRENCE AVE UNIT 1
NORRIDGE IL
60706-3292
US

V. Phone/Fax

Practice location:
  • Phone: 219-491-3376
  • Fax:
Mailing address:
  • Phone: 708-296-5681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10004813A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: