MEDICARE: AMBER L LENSTROM 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		IN
2	363A00000X	Physician Assistant	085.003819	IL
3	363A00000X	Physician Assistant	124234	IA
4	363A00000X	Physician Assistant	8496-23	WI

General Provider Information

NPI Number	:	1881994432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER L LENSTROM PA-C

Provider Business Mailing Address
First Line	:	5757 N LINCOLN AVE
Second Line	:	SUITE 27
City	:	CHICAGO
State	:	IL
Zip	:	60659-4714
Country	:	US
Telephone Number	:	773-728-5133
Fax Number	:	773-728-5134

Provider Business Practice Location Address
First Line	:	5757 N LINCOLN AVE
Second Line	:	SUITE 27
City	:	CHICAGO
State	:	IL
Zip	:	60659-4714
Country	:	US
Telephone Number	:	773-728-5133
Fax Number	:	773-728-5134

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

Provider Enumeration Date	:	10/29/2010
Last Update Date	:	02/04/2026

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