Provider Demographics
NPI:1508984428
Name:VALKENBURG, JUDY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:
Last Name:VALKENBURG
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 1:5841 SOUTH MARYLAND AVE
Mailing Address - Street 2:MC 6054
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:MC 6054
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-702-5290
Practice Address - Fax:773-702-1196
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ55723Medicare UPIN
ILK22288Medicare ID - Type UnspecifiedPROVIDER NUMBER