Provider Demographics
NPI:1245937366
Name:SUMAGUI, ABEGAIL B (PA-C)
Entity type:Individual
Prefix:
First Name:ABEGAIL
Middle Name:B
Last Name:SUMAGUI
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 1:4626 N HAMLIN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-9555
Mailing Address - Country:US
Mailing Address - Phone:815-919-9917
Mailing Address - Fax:
Practice Address - Street 1:5801 W CORCORAN PLACE
Practice Address - Street 2:APT 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644
Practice Address - Country:US
Practice Address - Phone:815-919-9917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-09
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant