Provider Demographics
NPI:1952733818
Name:SAMVEL, KSENIA (PA-C)
Entity Type:Individual
Prefix:
First Name:KSENIA
Middle Name:
Last Name:SAMVEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KSENIA
Other - Middle Name:
Other - Last Name:RAMOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1425 N HUNT CLUB RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-2632
Mailing Address - Country:US
Mailing Address - Phone:847-548-2200
Mailing Address - Fax:847-548-2865
Practice Address - Street 1:1425 N HUNT CLUB RD STE 100
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-2632
Practice Address - Country:US
Practice Address - Phone:847-548-2200
Practice Address - Fax:847-548-2865
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08386363AM0700X
IL085.004974363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical