Individual
MIA SORKIN KEHOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5841 S MARYLAND AVE # MC2050, CHICAGO, IL 60637-1443
(773) 702-6123
Mailing address
1112 44TH DR APT 6D, LONG ISLAND CITY, NY 11101-6357
(732) 754-6711
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085006623
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1152638
NCCPA
IL
Enumeration date
07/12/2018
Last updated
05/01/2023
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