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NPI Code Detail

MEDICARE: ANNA ELLERBROEK PA

MEDICARE: ANNA ELLERBROEK PA
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
1363A00000XPhysician AssistantIL

General Provider Information

NPI Number : 1124006010
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNA ELLERBROEK PA
Provider Business Mailing Address
First Line : 11475 N 2ND ST
Second Line :
City : MACHESNEY PARK
State : IL
Zip : 61115-1285
Country : US
Telephone Number : 815-654-8000
Fax Number : 815-654-8020
Provider Business Practice Location Address
First Line : 11475 N 2ND ST
Second Line :
City : MACHESNEY PARK
State : IL
Zip : 61115-1285
Country : US
Telephone Number : 815-654-8000
Fax Number : 815-654-8020
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2006
Last Update Date : 07/09/2007

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Directions to “ ANNA ELLERBROEK PA” Practice Location

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