Provider Demographics
NPI:1215712583
Name:LINTNER, TAYLOR (PA-C)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:LINTNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 SKOKIE BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4038
Mailing Address - Country:US
Mailing Address - Phone:847-497-2020
Mailing Address - Fax:847-497-2002
Practice Address - Street 1:900 SKOKIE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4038
Practice Address - Country:US
Practice Address - Phone:847-497-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-25
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
IL363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant