Individual
SAMANTHA KLOSAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2801 FINLEY RD STE 220, DOWNERS GROVE, IL 60515-1039
(630) 261-9393
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085008117
IL
363AS0400X
Surgical Physician Assistant
Primary
085-008117
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/29/2020
Last updated
10/09/2024
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