Provider Demographics
NPI:1710237748
Name:JELINSKI, JUSTIN W (PA-C)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:W
Last Name:JELINSKI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2030 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-5460
Mailing Address - Country:US
Mailing Address - Phone:309-343-3570
Mailing Address - Fax:309-343-3571
Practice Address - Street 1:712 S MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3279
Practice Address - Country:US
Practice Address - Phone:847-362-1848
Practice Address - Fax:847-362-3351
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN10001450A363A00000X
IL085.004721363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant