Individual
COLLEEN BIRD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2631 WILLIAMSBURG AVE STE 302, GENEVA, IL 60134-1128
(630) 377-8500
Mailing address
1860 PAYSPHERE CIR, CHICAGO, IL 60674-3269
(630) 469-2000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085001730
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
206147
MEDICARE PTAN (GROUP)
IL
01
—
206147103
MEDICARE PTAN (INDIVIDUAL)
IL
01
—
CA4748
MEDICARE RAILROAD (GROUPPTAN)
IL
01
—
P01209459
MEDICARE RAILROAD (PROVIDER PTAN)
IL
Enumeration date
07/13/2006
Last updated
02/27/2019
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