Provider Demographics
NPI:1841512027
Name:COLI, VICTORIA LEE (PA-C)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LEE
Last Name:COLI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:LEE
Other - Last Name:CIRALDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2100 PFINGSTEN RD
Mailing Address - Street 2:DEPARTMENT OF ORTHOPEDIC SURGERY
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-1301
Mailing Address - Country:US
Mailing Address - Phone:847-657-5815
Mailing Address - Fax:847-657-3724
Practice Address - Street 1:2100 PFINGSTEN RD
Practice Address - Street 2:DEPARTMENT OF ORTHOPEDIC SURGERY
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1301
Practice Address - Country:US
Practice Address - Phone:847-657-5815
Practice Address - Fax:847-657-3724
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.003625363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant