Provider Demographics
NPI:1356693006
Name:DOLEZAL, LINDSEY R (PA-C)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:R
Last Name:DOLEZAL
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9650 GROSS POINT RD
Mailing Address - Street 2:SUITE 2900
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1214
Mailing Address - Country:US
Mailing Address - Phone:847-866-7846
Mailing Address - Fax:224-251-2905
Practice Address - Street 1:9650 GROSS POINT RD
Practice Address - Street 2:SUITE 2900
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1214
Practice Address - Country:US
Practice Address - Phone:847-866-7846
Practice Address - Fax:224-251-2905
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2018-02-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL085.004954363A00000X
AZ5275363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant