Provider Demographics
NPI:1821233024
Name:SADONIS, TARA N (PA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:N
Last Name:SADONIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT CH 19153
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60055-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2852 EYDE PKWY
Practice Address - Street 2:SUITE 175
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5378
Practice Address - Country:US
Practice Address - Phone:517-333-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MITS005449363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical