Provider Demographics
NPI:1770890758
Name:HAWKINS, MEGAN S (PA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:S
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:M
Other - Last Name:SVOBODA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1725 W HARRISON ST
Mailing Address - Street 2:SUITE 774
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3841
Mailing Address - Country:US
Mailing Address - Phone:312-738-3732
Mailing Address - Fax:312-942-7048
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:SUITE 774
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-738-3732
Practice Address - Fax:312-942-7048
Is Sole Proprietor?:No
Enumeration Date:2010-09-11
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-003745363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant