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NPI Code Detail

MEDICARE: MRS. LANA TYMOUCH PA-C

MEDICARE: MRS. LANA TYMOUCH 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 Assistant085001905IL

General Provider Information

NPI Number : 1609818996
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LANA TYMOUCH PA-C
Provider Business Mailing Address
First Line : 850 S WABASH AVE
Second Line : STE 301
City : CHICAGO
State : IL
Zip : 60605-3641
Country : US
Telephone Number : 312-583-1066
Fax Number : 312-583-1897
Provider Business Practice Location Address
First Line : 850 S WABASH AVE
Second Line : STE 301
City : CHICAGO
State : IL
Zip : 60605-3641
Country : US
Telephone Number : 312-583-1066
Fax Number : 312-583-1897
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2006
Last Update Date : 02/10/2017

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Directions to “ MRS. LANA TYMOUCH PA-C” Practice Location

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