Provider Demographics
NPI:1427420579
Name:PLAGGE, KELSEY A (PA-C)
Entity type:Individual
Prefix:MS
First Name:KELSEY
Middle Name:A
Last Name:PLAGGE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:A
Other - Last Name:BLUMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1000 N WESTMORELAND RD # LEVEL1
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1658
Mailing Address - Country:US
Mailing Address - Phone:847-582-2134
Mailing Address - Fax:847-535-7285
Practice Address - Street 1:1000 N WESTMORELAND RD # LEVEL1
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1658
Practice Address - Country:US
Practice Address - Phone:847-582-2134
Practice Address - Fax:847-535-7285
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.005673363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085005673OtherSTATE LICENSURE