Individual
AMANDA L FRAKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
650 S RANDALL RD, ALGONQUIN, IL 60102-5944
(815) 398-9491
(815) 381-7498
Mailing address
BOX 78534, MILWAUKEE, WI 53278-8534
(815) 398-9491
(815) 381-7498
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085006483
IL
363A00000X
Physician Assistant
10001053A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000600746
ANTHEM
IN
01
—
085006483
ILLINOIS PHYSICIAN ASSISTANT LICENSE
IL
05
—
300005114
—
IN
01
—
P01291690
RAILROAD MEDICARE
IN
Enumeration date
08/31/2007
Last updated
12/13/2021
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