Provider Demographics
NPI:1649237959
Name:NITA, ADELIN (PA C)
Entity Type:Individual
Prefix:MR
First Name:ADELIN
Middle Name:
Last Name:NITA
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 1:2 TRANSAM PLAZA DR STE 410
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-4290
Mailing Address - Country:US
Mailing Address - Phone:866-259-1631
Mailing Address - Fax:855-618-2629
Practice Address - Street 1:2 TRANSAM PLAZA DR STE 410
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4290
Practice Address - Country:US
Practice Address - Phone:866-259-1631
Practice Address - Fax:855-618-2629
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002641363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085002641Medicaid
ILK23778Medicare ID - Type Unspecified
IL085002641Medicaid
Q60140Medicare UPIN