Provider Demographics
NPI:1669560355
Name:MISSYGAR, JOANNA (PA-C)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:MISSYGAR
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 1:1460 MARKET ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-4643
Mailing Address - Country:US
Mailing Address - Phone:847-813-0700
Mailing Address - Fax:847-813-0797
Practice Address - Street 1:1460 MARKET ST
Practice Address - Street 2:SUITE 300
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016-4643
Practice Address - Country:US
Practice Address - Phone:847-813-0700
Practice Address - Fax:847-813-0797
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-002429363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical