Provider Demographics
NPI:1578861258
Name:CZUBA, CYNTHIA L (PA)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:CZUBA
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:62647 COLLECTION CENTER DR
Mailing Address - Street 2:STE 900
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60693-0626
Mailing Address - Country:US
Mailing Address - Phone:812-962-6407
Mailing Address - Fax:
Practice Address - Street 1:3701 ALGONQUIN RD
Practice Address - Street 2:STE 900
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-3127
Practice Address - Country:US
Practice Address - Phone:847-577-0620
Practice Address - Fax:847-577-1475
Is Sole Proprietor?:No
Enumeration Date:2011-03-04
Last Update Date:2016-08-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL085.003913363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400281418Medicare PIN
ILF400281417Medicare PIN