Provider Demographics
NPI:1942802517
Name:FAVIA, MEGAN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:FAVIA
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12059 ARLENE DR
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-6813
Mailing Address - Country:US
Mailing Address - Phone:708-846-5459
Mailing Address - Fax:
Practice Address - Street 1:4400 W 95TH ST STE 408
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2662
Practice Address - Country:US
Practice Address - Phone:708-346-4055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant