Provider Demographics
NPI:1740555044
Name:MINDICK, GITTEL (PA-C)
Entity type:Individual
Prefix:
First Name:GITTEL
Middle Name:
Last Name:MINDICK
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 1:6001 W CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-2018
Mailing Address - Country:US
Mailing Address - Phone:708-656-5230
Mailing Address - Fax:
Practice Address - Street 1:6001 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-2018
Practice Address - Country:US
Practice Address - Phone:708-656-5230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.004706363A00000X
FLPA9106302363A00000X
NY015325-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant