Provider Demographics
NPI:1447396114
Name:PECARD, JAMES DAVID IV (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DAVID
Last Name:PECARD
Suffix:IV
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:2744 N BOSWORTH AVE APT 2W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1136
Mailing Address - Country:US
Mailing Address - Phone:630-747-3020
Mailing Address - Fax:
Practice Address - Street 1:3600 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2319
Practice Address - Country:US
Practice Address - Phone:773-782-2800
Practice Address - Fax:773-782-5042
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002163363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant