MEDICARE: MEGAN D LINDLEY PA-C, ATC

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	174400000X	Specialist	096002659	IL
2	363A00000X	Physician Assistant	085.005710	IL

General Provider Information

NPI Number	:	1801913769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN D LINDLEY PA-C, ATC

Provider Business Mailing Address
First Line	:	561 W DIVERSEY PKWY STE 215
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1682
Country	:	US
Telephone Number	:	773-906-4546
Fax Number	:

Provider Business Practice Location Address
First Line	:	561 W DIVERSEY PKWY STE 215
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1682
Country	:	US
Telephone Number	:	773-906-4546
Fax Number	:

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

Provider Enumeration Date	:	03/24/2007
Last Update Date	:	09/28/2023

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