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NPI Code Detail

MEDICARE: ALYSSA BOBAK PA-C

MEDICARE: ALYSSA BOBAK 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 Assistant085.005660IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1NONEOTHERN/A

General Provider Information

NPI Number : 1700256716
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALYSSA BOBAK PA-C
Provider Business Mailing Address
First Line : 1 E SUPERIOR ST STE 306
Second Line :
City : CHICAGO
State : IL
Zip : 60611-2595
Country : US
Telephone Number : 312-754-9404
Fax Number : 312-754-9402
Provider Business Practice Location Address
First Line : 3665 N BROADWAY ST
Second Line :
City : CHICAGO
State : IL
Zip : 60613-4567
Country : US
Telephone Number : 773-496-4433
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2015
Last Update Date : 04/11/2019

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Directions to “ ALYSSA BOBAK PA-C” Practice Location

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