Provider Demographics
NPI:1033685706
Name:ULASZEK, MIRANDA LEIGH (PA-C)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:LEIGH
Last Name:ULASZEK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:LEIGH
Other - Last Name:ORLANDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2900 FOXFIELD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-5799
Mailing Address - Country:US
Mailing Address - Phone:630-377-6500
Mailing Address - Fax:630-377-6577
Practice Address - Street 1:2900 FOXFIELD RD STE 100
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-5799
Practice Address - Country:US
Practice Address - Phone:630-377-6500
Practice Address - Fax:630-377-6577
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant