Basic Information
| Provider Information | |||||||||
| NPI: | 1629470315 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHALLMAN | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9711 SKOKIE BLVD | ||||||||
| Address2: | SUITE J | ||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600771384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476759711 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9711 SKOKIE BLVD | ||||||||
| Address2: | SUITE J | ||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600771384 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476759711 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2014 | ||||||||
| LastUpdateDate: | 09/24/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 085-005169 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 085-005169 | 01 | IL | ILLINOIS LICENSE | OTHER |