MEDICARE: CAITLIN GRIFFIN PORTER 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	085.005224	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	085005224	OTHER	IL	STATE LICENSE

General Provider Information

NPI Number	:	1639574155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLIN GRIFFIN PORTER PA-C

Provider Business Mailing Address
First Line	:	604 DAWES ST
Second Line	:
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-3106
Country	:	US
Telephone Number	:	847-234-3250
Fax Number	:

Provider Business Practice Location Address
First Line	:	959 S WAUKEGAN RD FL 2
Second Line	:
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-2654
Country	:	US
Telephone Number	:	847-234-3250
Fax Number	:	847-234-7765

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

Provider Enumeration Date	:	10/27/2014
Last Update Date	:	02/02/2026

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