Provider Demographics
NPI:1922723022
Name:DODIS, ABIGAIL MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:MARIE
Last Name:DODIS
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 1:19 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-3017
Mailing Address - Country:US
Mailing Address - Phone:630-765-1603
Mailing Address - Fax:
Practice Address - Street 1:373 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-3733
Practice Address - Country:US
Practice Address - Phone:847-608-6068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty