Individual
MR. WILLIAM BLAKE CIVILETTA-KALICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2520 ELISHA AVENUE, ZION, IL 60099
(414) 325-7246
(414) 325-3770
Mailing address
2361 PAYSPHERE CIRCLE, CHICAGO, IL 60674
(414) 325-7246
(414) 325-3770
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.003749
IL
363A00000X
Physician Assistant
1748023
WI
Other
Enumeration date
04/10/2006
Last updated
10/09/2018
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