MEDICARE: TARA E DORDEK 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	363A00000X	Physician Assistant	085.006750	IL

General Provider Information

NPI Number	:	1487217642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA E DORDEK PA-C

Provider Business Mailing Address
First Line	:	1550 W CARROLL AVE STE 210
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-1035
Country	:	US
Telephone Number	:	847-675-1400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 W CARROLL AVE STE 210
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-1035
Country	:	US
Telephone Number	:	847-675-1400
Fax Number	:

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

Provider Enumeration Date	:	04/15/2019
Last Update Date	:	03/16/2026

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Directions to “ TARA E DORDEK PA-C” Practice Location

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