Provider Demographics
NPI:1003168378
Name:HOYERT, KELLY M (PA-C)
Entity Type:Individual
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First Name:KELLY
Middle Name:M
Last Name:HOYERT
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:840 S WOOD ST
Mailing Address - Street 2:435E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4325
Mailing Address - Country:US
Mailing Address - Phone:312-355-1493
Mailing Address - Fax:312-355-1987
Practice Address - Street 1:1740 W TAYLOR ST
Practice Address - Street 2:3F OCC
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7232
Practice Address - Country:US
Practice Address - Phone:312-355-4300
Practice Address - Fax:312-413-1206
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2015-02-11
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Provider Licenses
StateLicense IDTaxonomies
IL085004493363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1003168378Medicare NSC