Provider Demographics
NPI:1699219972
Name:HENION, ALEXIS E (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:E
Last Name:HENION
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4015 N MILWAUKEE AVE UNIT 216
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-3864
Mailing Address - Country:US
Mailing Address - Phone:585-415-7817
Mailing Address - Fax:
Practice Address - Street 1:1910 1ST ST STE 2N
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3145
Practice Address - Country:US
Practice Address - Phone:847-813-2559
Practice Address - Fax:847-780-4294
Is Sole Proprietor?:No
Enumeration Date:2016-12-06
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085-005925363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant