Provider Demographics
NPI:1760615132
Name:HUBJER, LAMIJA (PA-C, MMS)
Entity Type:Individual
Prefix:MS
First Name:LAMIJA
Middle Name:
Last Name:HUBJER
Suffix:
Gender:F
Credentials:PA-C, MMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5219 W MADISON ST STE 4
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-4153
Mailing Address - Country:US
Mailing Address - Phone:773-378-4823
Mailing Address - Fax:773-378-9401
Practice Address - Street 1:5219 W MADISON ST STE 4
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-4153
Practice Address - Country:US
Practice Address - Phone:773-378-4823
Practice Address - Fax:773-378-9401
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003523363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085003523OtherLICENSE
IL745950001Medicare PIN