Provider Demographics
NPI:1558688531
Name:MARKHAM, ANDREA S (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:S
Last Name:MARKHAM
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 1:351 DELNOR DR
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4222
Mailing Address - Country:US
Mailing Address - Phone:630-938-8550
Mailing Address - Fax:630-938-8849
Practice Address - Street 1:351 DELNOR DR
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4222
Practice Address - Country:US
Practice Address - Phone:630-938-8550
Practice Address - Fax:630-938-8849
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-003398363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206147252OtherMEDICARE PTAN (INDIVIDUAL)
IL206147OtherMEDICARE PTAN (GROUP)