Provider Demographics
NPI:1255716320
Name:KLASSMAN, FATIMA M (PA-C)
Entity type:Individual
Prefix:
First Name:FATIMA
Middle Name:M
Last Name:KLASSMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:FATIMA
Other - Middle Name:M
Other - Last Name:FAROOQI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1425 NORTH HUNT CLUB ROAD
Mailing Address - Street 2:STE 100
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-2632
Mailing Address - Country:US
Mailing Address - Phone:847-548-2020
Mailing Address - Fax:847-548-2865
Practice Address - Street 1:1425 NORTH HUNT CLUB ROAD
Practice Address - Street 2:STE 100
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-2632
Practice Address - Country:US
Practice Address - Phone:847-548-2020
Practice Address - Fax:847-548-2865
Is Sole Proprietor?:No
Enumeration Date:2015-07-29
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4759-23363A00000X
IL085006448363A00000X
AZ6082363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant