Provider Demographics
NPI:1346238466
Name:ZEPKA, TERESA A (PA-C)
Entity type:Individual
Prefix:MISS
First Name:TERESA
Middle Name:A
Last Name:ZEPKA
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 1:15300 WEST AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4686
Mailing Address - Country:US
Mailing Address - Phone:708-226-2870
Mailing Address - Fax:708-226-2390
Practice Address - Street 1:15300 WEST AVE STE 210
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4686
Practice Address - Country:US
Practice Address - Phone:708-226-2870
Practice Address - Fax:708-226-2390
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056282363AM0700X
IL085010508363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical