Provider Demographics
NPI:1295886356
Name:GEORGE-MICHALIK, CYNTHIA A (PA-C)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:GEORGE-MICHALIK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:A
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2001 S WIESBROOK RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-7813
Mailing Address - Country:US
Mailing Address - Phone:630-614-4000
Mailing Address - Fax:630-614-4048
Practice Address - Street 1:2001 S WIESBROOK RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189
Practice Address - Country:US
Practice Address - Phone:630-614-4000
Practice Address - Fax:630-614-4048
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085000582207Q00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211104OtherMEDICARE PTAN (GROUP)
IL592050OtherMEDICARE PTAN (GROUP)
IL592050002OtherMEDICARE PTAN (INDIVIDUAL)
ILK15256OtherMEDICARE PTAN (INDIVIDUAL)
IL211104OtherMEDICARE PTAN (GROUP)