MEDICARE: JONATHAN GARRETT P.A.

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	085-002206	IL

General Provider Information

NPI Number	:	1558367482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN GARRETT P.A.

Provider Business Mailing Address
First Line	:	900 RAND RD STE 300
Second Line	:	ATTN; RAQUEL LEON
City	:	DES PLAINES
State	:	IL
Zip	:	60016-2359
Country	:	US
Telephone Number	:	847-324-3976
Fax Number	:

Provider Business Practice Location Address
First Line	:	9000 WAUKEGAN RD
Second Line	:	SUITE 200
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-2127
Country	:	US
Telephone Number	:	847-375-3000
Fax Number	:

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	08/29/2012

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