Provider Demographics
NPI:1528000114
Name:MESSMER, TANIA (PA-C)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:MESSMER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TANIA
Other - Middle Name:
Other - Last Name:FLITER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:17W755 BUTTERFIELD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-4253
Mailing Address - Country:US
Mailing Address - Phone:630-827-0100
Mailing Address - Fax:630-827-0103
Practice Address - Street 1:17W755 BUTTERFIELD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4253
Practice Address - Country:US
Practice Address - Phone:630-827-0100
Practice Address - Fax:630-827-0103
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002586363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ60858Medicare UPIN
ILK24182Medicare ID - Type Unspecified