Individual
ALICIA RENEE HIGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1701 E COLLEGE AVE, DEPARTMENT OF ORTHOPAEDICS, BLOOMINGTON, IL 61704-2101
(309) 664-3038
(309) 664-3119
Mailing address
1701 E COLLEGE AVE, DEPARTMENT OF ORTHOPAEDICS, BLOOMINGTON, IL 61704-2101
(309) 664-3038
(309) 664-3119
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085003359
IL
363AS0400X
Surgical Physician Assistant
085003359
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085003359
LICENSE
IL
01
—
IL2613
MEDICARE GROUP PTAN
IL
01
—
IL2613049
MEDICARE INDIVIDUAL PTAN
IL
Enumeration date
11/09/2006
Last updated
03/07/2023
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