Provider Demographics
NPI:1295941573
Name:TANIA MIKAITIS APN SC
Entity type:Organization
Organization Name:TANIA MIKAITIS APN SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MIKAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:APNCNP
Authorized Official - Phone:312-404-0244
Mailing Address - Street 1:956 BURGESS CIR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1205
Mailing Address - Country:US
Mailing Address - Phone:312-404-0244
Mailing Address - Fax:312-276-4299
Practice Address - Street 1:956 BURGESS CIR
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1205
Practice Address - Country:US
Practice Address - Phone:312-404-0244
Practice Address - Fax:312-276-4299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005514363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209005514OtherLICENSED APNCNP
IL1104873140OtherTYPE I NPI
K37843Medicare PIN
Q51696Medicare UPIN