Provider Demographics
NPI:1043509607
Name:MAMTORA, SEEMA R (PA-C)
Entity Type:Individual
Prefix:
First Name:SEEMA
Middle Name:R
Last Name:MAMTORA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 COMMERCE DR STE 700
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8865
Mailing Address - Country:US
Mailing Address - Phone:312-732-4490
Mailing Address - Fax:312-732-4491
Practice Address - Street 1:1001 COMMERCE DR STE 700
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-8865
Practice Address - Country:US
Practice Address - Phone:312-732-4490
Practice Address - Fax:312-732-4491
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004008363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical