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NPI Code Detail

MEDICARE: MR. JAMES DAVID PECARD IV PA-C

MEDICARE: MR. JAMES DAVID PECARD IV 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
1363A00000XPhysician Assistant085002163IL

General Provider Information

NPI Number : 1447396114
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES DAVID PECARD IV PA-C
Provider Business Mailing Address
First Line : 2744 N BOSWORTH AVE APT 2W
Second Line :
City : CHICAGO
State : IL
Zip : 60614-1136
Country : US
Telephone Number : 630-747-3020
Fax Number :
Provider Business Practice Location Address
First Line : 3600 W FULLERTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-2319
Country : US
Telephone Number : 773-782-2800
Fax Number : 773-782-5042
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2007
Last Update Date : 09/29/2020

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