Provider Demographics
NPI:1164679247
Name:CALICE, ALEXIS M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ALEXIS
Middle Name:M
Last Name:CALICE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ALEXIS
Other - Middle Name:M
Other - Last Name:MANDLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:675 N SAINT CLAIR ST
Mailing Address - Street 2:15-200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5975
Mailing Address - Country:US
Mailing Address - Phone:312-695-8182
Mailing Address - Fax:312-695-4303
Practice Address - Street 1:675 N SAINT CLAIR ST
Practice Address - Street 2:15-200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5975
Practice Address - Country:US
Practice Address - Phone:312-695-8182
Practice Address - Fax:312-695-4303
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL08.003258363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical