Individual
SARA K ZIDLICKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
290 SPRINGFIELD DR, SUITE 290, BLOOMINGDALE, IL 60108-2214
(630) 893-9660
(630) 893-9668
Mailing address
290 SPRINGFIELD DR, SUITE 290, BLOOMINGDALE, IL 60108-2214
(630) 893-9660
(630) 893-9668
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085003137
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085003137
LICENSE
IL
01
—
920540
MEDICARE PTAN (GROUP)
IL
01
—
F400175927
MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
11/12/2007
Last updated
04/07/2015
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