Provider Demographics
NPI:1467541813
Name:SAWYER, SOONJA L (PA-C)
Entity Type:Individual
Prefix:
First Name:SOONJA
Middle Name:L
Last Name:SAWYER
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 1:676 N SAINT CLAIR ST STE 850
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3124
Mailing Address - Country:US
Mailing Address - Phone:312-695-1338
Mailing Address - Fax:
Practice Address - Street 1:676 N SAINT CLAIR ST STE 850
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3124
Practice Address - Country:US
Practice Address - Phone:312-695-1338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03596363A00000X
IL085.003668363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P84671Medicare UPIN
8A5322Medicare ID - Type Unspecified