Provider Demographics
NPI:1710953104
Name:POPE, KATIE A (PA-C)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:A
Last Name:POPE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:A
Other - Last Name:GARRETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:929 W HIGGINS RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60195-3203
Mailing Address - Country:US
Mailing Address - Phone:847-285-4200
Mailing Address - Fax:847-885-0130
Practice Address - Street 1:929 W HIGGINS RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60195-3203
Practice Address - Country:US
Practice Address - Phone:847-285-4200
Practice Address - Fax:847-885-0130
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-002112363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363062013OtherEIN
Q07748Medicare UPIN
ILK33159Medicare PIN
ILK33158Medicare PIN