Provider Demographics
NPI:1982858601
Name:GEORGE, SWETA V (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SWETA
Middle Name:V
Last Name:GEORGE
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 1:121 FAIRFIELD WAY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1588
Mailing Address - Country:US
Mailing Address - Phone:630-529-7427
Mailing Address - Fax:
Practice Address - Street 1:121 FAIRFIELD WAY
Practice Address - Street 2:SUITE 207
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1588
Practice Address - Country:US
Practice Address - Phone:630-529-7427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-07
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003361363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085003361OtherIL STATE LICENSE