Individual
MRS. KATHLEEN LACCI BIENIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, MMSC
Contact information
Practice address
2545 S KING DR, SYKES ADVOCATE MEDICAL GROUP, CHICAGO, IL 60616-2441
(312) 842-7117
(312) 808-3383
Mailing address
2545 S KING DR, SYKES ADVOCATE MEDICAL GROUP, CHICAGO, IL 60616-2441
(312) 842-7117
(312) 808-3383
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085003678
IL
363AM0700X
Medical Physician Assistant
085-003678
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085-003678
STATE LICENSE
IL
Enumeration date
03/31/2010
Last updated
12/13/2021
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