Provider Demographics
NPI:1619469277
Name:BAMBERGER, PAUL GEORGE (PA-C)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:GEORGE
Last Name:BAMBERGER
Suffix:
Gender:M
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 1:694 SHEEHAN AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-6367
Mailing Address - Country:US
Mailing Address - Phone:312-318-1759
Mailing Address - Fax:
Practice Address - Street 1:1213 OAK ST
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-2006
Practice Address - Country:US
Practice Address - Phone:630-504-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant