Individual
MR. ETHAN JAMES KSIAZEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
225 E CHICAGO AVE, CHICAGO, IL 60611-2991
(312) 227-4000
Mailing address
225 E CHICAGO AVE, CHICAGO, IL 60611-2991
(312) 227-4000
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085010244
IA
Other
Enumeration date
12/18/2023
Last updated
04/25/2024
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