MEDICARE: MS. KATHLEEN DEANS 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	363AM0700X	Medical Physician Assistant	085-002590	IL

General Provider Information

NPI Number	:	1811918006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN DEANS PA-C

Provider Business Mailing Address
First Line	:	17 SORRENTO DR
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1752
Country	:	US
Telephone Number	:	708-218-4449
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 SORRENTO DR
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1752
Country	:	US
Telephone Number	:	708-218-4449
Fax Number	:

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

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	07/01/2009

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