| Jacob Tyler Pike, PA-C | |
|
2650 Ridge Ave, Evanston, IL 60201-1700 | |
| (847) 525-7451 | |
| Not Available |
| Full Name | Jacob Tyler Pike |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant |
| Location | 2650 Ridge Ave, Evanston, Illinois |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063109627 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | 085009824 (Illinois) | Primary |
| 390200000X | Student In An Organized Health Care Education/training Program | (NU) | Secondary |
| Entity Name | Endeavor Health Medical Group |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1497701882 PECOS PAC ID: 2163334699 Enrollment ID: O20040524000118 |
| Mailing Address | Practice Location Address |
|---|---|
| Jacob Tyler Pike, PA-C 2650 Ridge Ave, Evanston, IL 60201-1700 Ph: (847) 525-7451 | Jacob Tyler Pike, PA-C 2650 Ridge Ave, Evanston, IL 60201-1700 Ph: (847) 525-7451 |
Mrs. Etel Zeveleva, PA-C Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 107 Clyde Ave, Evanston, IL 60202 Phone: 847-869-7389 |
Alexis Carroll, Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2650 Ridge Ave, Evanston, IL 60201 Phone: 847-570-2000 |
Ms. Margaret Miller Carter, PA-S2 Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2650 Ridge Ave Ste 2507, Evanston, IL 60201 Phone: 847-570-2560 Fax: 847-570-2930 |
Wajdey Nesheiwat, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2650 Ridge Ave., Dept. Of Surgery Walgreen 2507, Evanston, IL 60201 Phone: 847-570-2560 Fax: 847-570-2930 |
Bomy Kim, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2650 Ridge Ave Ste 1223, Evanston, IL 60201 Phone: 847-982-3171 |
Sheri Lynn Tokarczyk, PA Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 2650 Ridge Ave, Walgreen Building, Suite 2507, Evanston, IL 60201 Phone: 847-570-1171 Fax: 847-570-2930 |
Robert Logan Aitchison, PA-C Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 2650 Ridge Ave, Emergency Medicine Department, Evanston, IL 60201 Phone: 847-570-1353 |