Provider Demographics
NPI:1144545237
Name:BIENIA, KATHLEEN LACCI (PA-C, MMSC)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:LACCI
Last Name:BIENIA
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Gender:F
Credentials:PA-C, MMSC
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Mailing Address - Street 1:2545 S KING DR
Mailing Address - Street 2:SYKES ADVOCATE MEDICAL GROUP
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2441
Mailing Address - Country:US
Mailing Address - Phone:312-842-7117
Mailing Address - Fax:312-808-3383
Practice Address - Street 1:2545 S KING DR
Practice Address - Street 2:SYKES ADVOCATE MEDICAL GROUP
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2441
Practice Address - Country:US
Practice Address - Phone:312-842-7117
Practice Address - Fax:312-808-3383
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2021-12-13
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Provider Licenses
StateLicense IDTaxonomies
IL085-003678363AM0700X
IL085003678363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085-003678OtherSTATE LICENSE