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NPI Code Detail

MEDICARE: KRISTINE BOWERSOX PA-C

MEDICARE: KRISTINE BOWERSOX 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
1363A00000XPhysician Assistant8884WI
2363A00000XPhysician Assistant085004671IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1992139281
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTINE BOWERSOX PA-C
Provider Business Mailing Address
First Line : 29373 NETWORK PL
Second Line :
City : CHICAGO
State : IL
Zip : 60673-1293
Country : US
Telephone Number : 847-390-5900
Fax Number :
Provider Business Practice Location Address
First Line : 1775 DEMPSTER ST STE E592C
Second Line :
City : PARK RIDGE
State : IL
Zip : 60068-1143
Country : US
Telephone Number : 312-609-0300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2013
Last Update Date : 04/16/2026

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Directions to “ KRISTINE BOWERSOX PA-C” Practice Location

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