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NPI Code Detail

MEDICARE: KARI MICHELLE BOERSEN PA-C

MEDICARE: KARI MICHELLE BOERSEN 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 Assistant085-004868IL

General Provider Information

NPI Number : 1669802682
Entity Type Code : Individual
Provider Name (Legal Business Name) : KARI MICHELLE BOERSEN PA-C
Provider Business Mailing Address
First Line : 4119 N ASHLAND AVE
Second Line : UNIT 2
City : CHICAGO
State : IL
Zip : 60613-1880
Country : US
Telephone Number : 616-647-7174
Fax Number :
Provider Business Practice Location Address
First Line : 1817 S LOOMIS ST
Second Line :
City : CHICAGO
State : IL
Zip : 60608-3018
Country : US
Telephone Number : 312-666-6511
Fax Number : 312-666-1658
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2013
Last Update Date : 11/13/2013

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Directions to “ KARI MICHELLE BOERSEN PA-C” Practice Location

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