Provider Demographics
NPI:1679963821
Name:MUSCAVITCH, KELLY A (PA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:MUSCAVITCH
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Gender:F
Credentials:PA
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Mailing Address - Street 1:1000 N WESTMORELAND RD
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1658
Mailing Address - Country:US
Mailing Address - Phone:847-582-2134
Mailing Address - Fax:847-535-7285
Practice Address - Street 1:1000 N WESTMORELAND RD
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:847-582-2134
Practice Address - Fax:847-535-7285
Is Sole Proprietor?:No
Enumeration Date:2015-01-27
Last Update Date:2023-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL085005451363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant