MEDICARE: TARA BEHNKE 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	085-006118	IL

General Provider Information

NPI Number	:	1598204760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA BEHNKE PA-C

Provider Business Mailing Address
First Line	:	900 RAND RD STE 300
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60016-2359
Country	:	US
Telephone Number	:	847-324-3976
Fax Number	:	847-929-1154

Provider Business Practice Location Address
First Line	:	2923 N CALIFORNIA AVE STE 300
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-4677
Country	:	US
Telephone Number	:	773-777-9900
Fax Number	:	773-777-5927

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

Provider Enumeration Date	:	02/21/2017
Last Update Date	:	12/02/2024

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