Provider Demographics
NPI:1598746521
Name:STEWART, KARLA E (PA-C)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:E
Last Name:STEWART
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KARLA
Other - Middle Name:E
Other - Last Name:LOVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:307 GREENVIEW LN
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-6460
Mailing Address - Country:US
Mailing Address - Phone:847-322-3423
Mailing Address - Fax:
Practice Address - Street 1:1000 N WESTMORELAND RD FL 3
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1658
Practice Address - Country:US
Practice Address - Phone:847-535-8500
Practice Address - Fax:847-535-8488
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.005063363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41968400Medicaid
WI009932250Medicare PIN
P64124Medicare UPIN