Individual
MISS DOROTHY ANNE FEDOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
25 N WINFIELD RD, WINFIELD, IL 60190
(630) 933-4480
(630) 933-2009
Mailing address
25 N WINFIELD RD, WINFIELD, IL 60190-1295
(630) 933-4480
(630) 933-2009
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085001477
IL
363AS0400X
Surgical Physician Assistant
085001477
IL
363AS0400X
Surgical Physician Assistant
10001099A
IN
363AS0400X
Surgical Physician Assistant
2687-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1437216165
—
WI
01
—
206147
MEDICARE PTAN (GROUP)
IL
01
—
206147105
MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
01/02/2007
Last updated
05/15/2018
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