Provider Demographics
NPI:1114008448
Name:PADGETT, BRIDGET (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:PADGETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:
Other - Last Name:FRESKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:199 TOWN SQ
Practice Address - Street 2:STE A
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-3878
Practice Address - Country:US
Practice Address - Phone:630-871-6690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002769363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ74331Medicare UPIN
ILK34229Medicare ID - Type Unspecified