Provider Demographics
NPI:1285260844
Name:SAUM, KRISTA A (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:A
Last Name:SAUM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:380 E NORTHWEST HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2274
Mailing Address - Country:US
Mailing Address - Phone:847-813-0725
Mailing Address - Fax:847-813-0797
Practice Address - Street 1:661 W SHERIDAN RD APT 601
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3311
Practice Address - Country:US
Practice Address - Phone:281-777-9536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.007518363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant