Provider Demographics
NPI:1699929513
Name:BEHM, GWEN (PA-C)
Entity type:Individual
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First Name:GWEN
Middle Name:
Last Name:BEHM
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Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:401 N MICHIGAN AVENUE
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4264
Mailing Address - Country:US
Mailing Address - Phone:312-635-0973
Mailing Address - Fax:813-290-9691
Practice Address - Street 1:1200 LUTHER DR
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-5043
Practice Address - Country:US
Practice Address - Phone:219-663-3860
Practice Address - Fax:219-662-3055
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2015-10-29
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Provider Licenses
StateLicense IDTaxonomies
IN10001472A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant