Provider Demographics
NPI:1922086818
Name:OKSNEVAD, ERIK (PA)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:
Last Name:OKSNEVAD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11475 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MACHESNEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61115-1285
Mailing Address - Country:US
Mailing Address - Phone:815-654-8000
Mailing Address - Fax:815-654-8020
Practice Address - Street 1:11475 N 2ND ST
Practice Address - Street 2:
Practice Address - City:MACHESNEY PARK
Practice Address - State:IL
Practice Address - Zip Code:61115-1285
Practice Address - Country:US
Practice Address - Phone:815-654-8000
Practice Address - Fax:815-654-8020
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL85000535363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP16797Medicare UPIN
IL207480 - K03437Medicare PIN