Provider Demographics
NPI:1932695251
Name:BEVOLO, ANDREA RENEE (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:RENEE
Last Name:BEVOLO
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 1:737 N MICHIGAN AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-6662
Mailing Address - Country:US
Mailing Address - Phone:312-337-6960
Mailing Address - Fax:312-337-3601
Practice Address - Street 1:737 N MICHIGAN AVE STE 700
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-6662
Practice Address - Country:US
Practice Address - Phone:312-337-6960
Practice Address - Fax:312-337-3601
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085006765363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant