Provider Demographics
NPI:1700391794
Name:COLON, ALINA M (MMS, PA-C)
Entity Type:Individual
Prefix:
First Name:ALINA
Middle Name:M
Last Name:COLON
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2800 S CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-5107
Mailing Address - Country:US
Mailing Address - Phone:773-674-5468
Mailing Address - Fax:773-674-3578
Practice Address - Street 1:2800 S CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-5107
Practice Address - Country:US
Practice Address - Phone:773-674-5468
Practice Address - Fax:773-674-3578
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.006290363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant