MEDICARE: KRISTINA MALIEJUS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	085007094	IL
2	363A00000X	Physician Assistant	085.007094	IL

General Provider Information

NPI Number	:	1083276695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA MALIEJUS PA-C

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE STE 1223
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1700
Country	:	US
Telephone Number	:	847-982-6715
Fax Number	:	847-982-3394

Provider Business Practice Location Address
First Line	:	2650 RIDGE AVE STE 3507
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1778
Country	:	US
Telephone Number	:	847-570-2868
Fax Number	:	847-570-2827

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2019
Last Update Date	:	01/27/2022

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Directions to “ KRISTINA MALIEJUS PA-C” Practice Location

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