Provider Demographics
NPI:1972668077
Name:OZOG, KARA M (PA)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:M
Last Name:OZOG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:911 N ELM ST
Mailing Address - Street 2:STE 128
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3634
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:911 N ELM ST
Practice Address - Street 2:STE 128
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3634
Practice Address - Country:US
Practice Address - Phone:630-856-7460
Practice Address - Fax:630-655-9943
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-002504363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ57638Medicare UPIN