Individual
SAMANTHA WAITZMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
363 W ERIE ST STE 350, CHICAGO, IL 60654-6933
(312) 995-1955
Mailing address
820 SPRINGER DR, LOMBARD, IL 60148-6413
(708) 634-4602
(630) 495-1770
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-006222
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085-006222
STATE LICENSE
IL
Enumeration date
08/23/2017
Last updated
10/02/2018
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