Provider Demographics
NPI:1659422517
Name:EPSTEIN, DEBORAH S (PA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:S
Last Name:EPSTEIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 N SAINT CLAIR ST
Mailing Address - Street 2:SUITE 1835
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2927
Mailing Address - Country:US
Mailing Address - Phone:312-926-3535
Mailing Address - Fax:312-926-3585
Practice Address - Street 1:676 N SAINT CLAIR ST
Practice Address - Street 2:SUITE 1835
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2927
Practice Address - Country:US
Practice Address - Phone:312-926-3535
Practice Address - Fax:312-926-3585
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002337363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P24362Medicare UPIN