Provider Demographics
NPI:1255962445
Name:SERRANO, KEVIN JOSEPH (PA-C)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:JOSEPH
Last Name:SERRANO
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1952 MC DOWELL RD STE 305
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-6507
Mailing Address - Country:US
Mailing Address - Phone:386-837-8352
Mailing Address - Fax:
Practice Address - Street 1:1952 MC DOWELL RD STE 305
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-6507
Practice Address - Country:US
Practice Address - Phone:630-893-5230
Practice Address - Fax:630-893-5837
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085.007525363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant