Provider Demographics
NPI:1134121965
Name:OGINO-MCELLIGOTT, MAKIKO (PA-C)
Entity Type:Individual
Prefix:
First Name:MAKIKO
Middle Name:
Last Name:OGINO-MCELLIGOTT
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 1:525 E CONGRESS PKWY
Mailing Address - Street 2:100
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6245
Mailing Address - Country:US
Mailing Address - Phone:815-479-8020
Mailing Address - Fax:
Practice Address - Street 1:525 E CONGRESS PKWY
Practice Address - Street 2:100
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6245
Practice Address - Country:US
Practice Address - Phone:815-479-8020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2017-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-001932363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant