Provider Demographics
NPI:1174511851
Name:UGO-NEFF, GINA J (PA-C)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:J
Last Name:UGO-NEFF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:J
Other - Last Name:UGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1725 W HARRISON ST
Mailing Address - Street 2:SUITE 352
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3841
Mailing Address - Country:US
Mailing Address - Phone:312-563-5000
Mailing Address - Fax:312-563-5007
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:SUITE 352
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-563-5000
Practice Address - Fax:312-563-5007
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA794363AM0700X
IN10000651A363AM0700X
IL085.003394363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q05368Medicare UPIN
5514060036Medicare NSC
212210Medicare PIN
212210037Medicare PIN