Provider Demographics
NPI:1922288257
Name:KOBILJAK, ERIN ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:ELIZABETH
Last Name:KOBILJAK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ERIN
Other - Middle Name:ELIZABETH
Other - Last Name:HARDING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1041 W STEARNS RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-4509
Mailing Address - Country:US
Mailing Address - Phone:630-716-7500
Mailing Address - Fax:
Practice Address - Street 1:1041 W STEARNS RD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:IL
Practice Address - Zip Code:60103-4509
Practice Address - Country:US
Practice Address - Phone:630-716-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-03
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.003086363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK46702OtherMEDICARE PROVIDER ID
ILK46702Medicare UPIN