Individual
ELENA PETRUSEVSKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
840 W IRVING PARK RD, STE 301, CHICAGO, IL 60613-3011
(773) 975-3269
(773) 975-3270
Mailing address
PO BOX 3276, EVANSVILLE, IN 47731-3276
(812) 473-0181
(812) 473-5822
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085-004506
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085-004506
STATE OF IL LICENSE
IL
Enumeration date
12/14/2012
Last updated
09/17/2015
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