Individual
KAILEY M HLAVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
716 S MILWAUKEE AVE, LIBERTYVILLE, IL 60048-3225
(847) 362-1848
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-009618
IL
363AM0700X
Medical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4005-1398-701H
ILLINOIS STATE IDENTIFICATION CARD NUMBER
IL
01
—
H400-5139-8701
DRIVER'S LICENSE NO
IL
Enumeration date
02/22/2023
Last updated
04/07/2025
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