Provider Demographics
NPI:1730157470
Name:ZEMAN, KATHRYN M (PA)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:M
Last Name:ZEMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 S HENNEPIN AVE
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-3083
Mailing Address - Country:US
Mailing Address - Phone:815-288-7711
Mailing Address - Fax:815-285-8926
Practice Address - Street 1:102 S HENNEPIN AVE
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-3083
Practice Address - Country:US
Practice Address - Phone:815-288-7711
Practice Address - Fax:815-285-8926
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL554510Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
S88635Medicare UPIN