Violetta Mickiewicz, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

Practice address

4501 N Winchester Ave
3Rd Floor
Chicago, IL 60640-5265

Phone

(773) 250-0500

Fax

(773) 250-0497

NPI assigned

Aug 22, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Affinity Chiropractic Center SC

  • Medical Specialty Clinic/Center
  • Libertyville, IL
  • NPI 1619156361
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191456000000",
    "number": "1053427831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4501 WINCHESTER",
            "address_2": "3RD FLOOR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60640",
            "telephone_number": "773-250-0500",
            "fax_number": "773-250-0497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4501 N WINCHESTER AVE",
            "address_2": "3RD FLOOR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405265",
            "telephone_number": "773-250-0500",
            "fax_number": "773-250-0497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKIEWICZ",
        "first_name": "VIOLETTA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-22",
        "last_updated": "2007-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michrid Supplies LLC
• Cedomir Micic, PHARMD
• Dejan Micic
• Jennifer Mickelson, M.D.
• Lindsay Mickelson, LPC
• Marcia Mickle, NP
• Sophia Mickus
• Marla Micor, LCSW
• Micro Neuro Spine SC
• Micro Neuro Spine SC

• Surgical Physician Assistant in Chicago, IL
• Providers in Chicago, IL by specialty
• Surgical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.