Provider Demographics
NPI:1851726004
Name:BAZZETTA, ELIZABETH G (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:G
Last Name:BAZZETTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 E ERIE ST FL 13
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3926
Mailing Address - Country:US
Mailing Address - Phone:312-695-6800
Mailing Address - Fax:312-472-4871
Practice Address - Street 1:259 E ERIE ST FL 13
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3926
Practice Address - Country:US
Practice Address - Phone:312-695-6800
Practice Address - Fax:312-472-4871
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004793363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical