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NPI Code Detail

MEDICARE: EMMANUEL BARRON PA-C

MEDICARE: EMMANUEL BARRON 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
1363AM0700XMedical Physician Assistant085007419IL
2363AS0400XSurgical Physician Assistant085007419IL
3363A00000XPhysician Assistant085007419IL

General Provider Information

NPI Number : 1598398034
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMMANUEL BARRON PA-C
Provider Business Mailing Address
First Line : 680 N LAKE SHORE DR STE 924
Second Line :
City : CHICAGO
State : IL
Zip : 60611-8701
Country : US
Telephone Number : 312-475-5628
Fax Number : 866-954-5814
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 :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2020
Last Update Date : 09/29/2020

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Directions to “ EMMANUEL BARRON PA-C” Practice Location

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