=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245586627
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | INNA DILMAN PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2012
-----------------------------------------------------
Last Update Date | 08/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4711 GOLF RD STE 1200
-----------------------------------------------------
City | SKOKIE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60076-1200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 224-217-9019
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23143 N SANCTUARY CLUB DR
-----------------------------------------------------
City | KILDEER
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60047-8615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-682-4998
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 085.004494
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------