MEDICARE: MRS. ANGELA MARIE HUISMAN 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	1284	NE
2	363A00000X	Physician Assistant	085003225	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	085.003225	OTHER	IL	LICENSE

General Provider Information

NPI Number	:	1902972524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA MARIE HUISMAN PA-C

Provider Business Mailing Address
First Line	:	PO BOX 74008272
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-8272
Country	:	US
Telephone Number	:	702-899-0595
Fax Number	:	702-977-1496

Provider Business Practice Location Address
First Line	:	1725 S WABASH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-1219
Country	:	US
Telephone Number	:	872-231-3162
Fax Number	:

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

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	10/07/2025

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