Provider Demographics
NPI:1922512177
Name:MORK, JOSEPH N (PA-C)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:N
Last Name:MORK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 DIVISION DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554-5109
Mailing Address - Country:US
Mailing Address - Phone:630-315-1000
Mailing Address - Fax:630-315-1005
Practice Address - Street 1:414 DIVISION DR
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:60554-5109
Practice Address - Country:US
Practice Address - Phone:630-315-1000
Practice Address - Fax:630-315-1005
Is Sole Proprietor?:No
Enumeration Date:2017-11-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085006369363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant