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General NPI Number Information
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NPI Number | 1811751555
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Entity Type | Individual
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Provider Name | SYDNEY SOLEM PA, C
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Gender | Female
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Dates
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Enumeration Date | 02/13/2024
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Last Update Date | 02/20/2024
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Provider Practice Location Address
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Address Line | 5721 S MARYLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60637-1425
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Country | US
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Telephone | 224-330-8748
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Fax |
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Provider Business Mailing Address
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Address Line | 1438 N LEAVITT ST APT 1
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City | CHICAGO
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State | IL
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Zip | 60622-6452
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Country | US
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Telephone | 617-320-5100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085.010368
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License Number State | IL
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