MEDICARE: ASHTYN CHARLENE STANG 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	MA057179	PA
2	363AS0400X	Surgical Physician Assistant	085.005501	IL

General Provider Information

NPI Number	:	1700288990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHTYN CHARLENE STANG PA-C

Provider Business Mailing Address
First Line	:	880 W CENTRAL RD STE 4100
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-2383
Country	:	US
Telephone Number	:	847-618-4400
Fax Number	:	847-618-4409

Provider Business Practice Location Address
First Line	:	880 W CENTRAL RD STE 4100
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-2383
Country	:	US
Telephone Number	:	847-618-4400
Fax Number	:	847-618-4409

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

Provider Enumeration Date	:	09/19/2014
Last Update Date	:	07/21/2022

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