Provider Demographics
NPI:1124449558
Name:POND, ROBIN K (MMS, PA-C)
Entity type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:K
Last Name:POND
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:K
Other - Last Name:DANIELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5911 NORTHWEST HIGHWAY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014
Mailing Address - Country:US
Mailing Address - Phone:847-515-2200
Mailing Address - Fax:847-515-2328
Practice Address - Street 1:5911 NORTHWEST HIGHWAY
Practice Address - Street 2:SUITE 205
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014
Practice Address - Country:US
Practice Address - Phone:847-515-2200
Practice Address - Fax:847-515-2328
Is Sole Proprietor?:No
Enumeration Date:2014-01-03
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.004939363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant