MEDICARE: ALLYSON ELISABETH PATRICK

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	207Q00000X	Family Medicine Physician	209034984	IL

General Provider Information

NPI Number	:	1396692158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLYSON ELISABETH PATRICK

Provider Business Mailing Address
First Line	:	1032 W SHERIDAN RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-1537
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1032 W SHERIDAN RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-1537
Country	:	US
Telephone Number	:	312-241-9998
Fax Number	:

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

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/16/2026

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