LISA M. FANTROY (NPI# 1982799508) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982799508 |
| Entity Type | Individual |
| Full Name | LISA M. FANTROY |
| Credential | PA-C |
| Practice Address |
4001 Vollmer Rd. Olympia Fields IL 60461 |
| Mailing Address |
20110 Governors Hwy. Olympia Fields IL 60461 |
| Practice Telephone | 7084818883 |
| Practice Fax Number | 7084812917 |
| Mailing Telephone | 7087477960 |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2015-03-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 085001107 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | MEDICARE PTAN | IL5686021 | 01 |
| Street Address |
4001 VOLLMER RD. |
| City | OLYMPIA FIELDS |
| State | IL |
| Zip Code | 60461 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043311319 | Raghuvansh Kumar | Physical Medicine & Rehabilitation | 4001 Vollmer Rd., Olympia Fields, IL 60461-1073 | 2006-09-26 |
| 1861612475 | Sushma M. Raghavendra | Family Medicine | 4001 Vollmer Rd., Olympia Fields, IL 60461 | 2007-04-26 |
| 1245308048 | Jacqueline Payne | Family Medicine | 4001 Vollmer Rd., Olympia Fields, IL 60461-1073 | 2006-12-01 |
| 1336213297 | Mitali Roy | Hospitalist | 4001 Vollmer Rd., Olympia Fields, IL 60461-1010 | 2006-11-20 |
| 1699850610 | William Imlach | Family Medicine | 4001 Vollmer Rd., Olympia Fields, IL 60461-1073 | 2006-10-26 |
| 1720178734 | Rodey Wassef | Family Medicine | 4001 Vollmer Rd., Olympia Fields, IL 60461-1073 | 2006-10-13 |
| 1730274770 | Don Leroy Hollandsworth | Internal Medicine | 4001 Vollmer Rd., Olympia Fields, IL 60461-1073 | 2006-10-04 |
| 1508952011 | Edwin John Cook | Internal Medicine | 4001 Vollmer Rd., Olympia Fields, IL 60461 | 2006-10-04 |
| 1609961218 | Michael Rogers Olden | Internal Medicine | 4001 Vollmer Rd., Olympia Fields, IL 60461 | 2006-10-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609372564 | Katherine Gill Haddad | Student in an Organized Health Care Education/Training Program | 20201 S. Crawford Avenue, Attn: Postdoctoral Education, Olympia Fields, IL 60461 | 2018-03-31 |
| 1750886610 | Kim Minh Dang | Student in an Organized Health Care Education/Training Program | 20201 South Crawford, Olympia Fields, IL 60461 | 2018-03-23 |
| 1619484110 | Alexandra N. Douvas | Dentist | 20180 Governors Hwy, Ste 104, Olympia Fields, IL 60461 | 2018-01-05 |
| 1992258438 | Krystyne Doty | Nurse Practitioner | 3800 W 203rd St Ste 209, Olympia Fields, IL 60461 | 2016-08-02 |
| 1205286747 | Shirlene Umali | Registered Nurse | 20201 South Crawford Ave, Olympia Fields, IL 60461 | 2016-06-15 |
| 1386002590 | Touch of Wholeness Psychological Services, LLC | Psychologist | 20280 Governors Dr, Suite 207, Olympia Fields, IL 60461 | 2016-02-02 |
| 1063895357 | David Dardick | Dentist | 20180 Governors Hwy Ste 104, Olympia Fields, IL 60461 | 2015-07-04 |
| 1811378623 | Fins Healthcare Agency | Nursing Care | 3612 Lincohn Highway, Suite 19, Olympia Fields, IL 60461 | 2015-06-17 |
| 1285048959 | Garud Ranga Raj | Orthopaedic Surgery | 20817 Alexander St, Olympia Fields, IL 60461 | 2014-06-20 |
| 1811316334 | Brett Hapeman | Emergency Medicine | 20201 S Crawford, Attn: Postdoctoral Education, Olympia Fields, IL 60461 | 2014-04-11 |
| Find all providers in zip 60461 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972552529 | Lance A Kirby | Physician Assistant | 3700 W 203rd St Ste 111, Olympia Fields, IL 60461 | 2006-05-10 |
| 1710347406 | Adina Hattar | Physician Assistant | 3700 W 203rd St, Suite 301, Olympia Fields, IL 60461-1180 | 2016-02-24 |
| 1679904874 | Eammon Esteghamat | Physician Assistant | 20201 Crawford Ave, Olympia Fields, IL 60461-1010 | 2013-12-12 |
| 1598949760 | Don T Martinez Jr. | Physician Assistant | 4001 Vollmer Rd, Olympia Fields, IL 60461-3168 | 2007-12-24 |
| 1881762540 | Lori Jean Williams | Physician Assistant | 20110 Governors Hwy, Olympia Fields, IL 60461-1030 | 2006-12-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063010924 | Mckenzie Youngblood | Physician Assistant | 28653 Wren Ln, Jerseyville, IL 62052-6501 | 2020-10-13 |
| 1548877400 | Shawn Milhauser | Physician Assistant | 1014 N Mill St, Pontiac, IL 61764-1332 | 2020-09-25 |
| 1982210654 | Brittany Michelle Weber | Physician Assistant | 525 E Congress Pkwy Ste 200, Crystal Lake, IL 60014-6271 | 2020-09-18 |
| 1003421603 | Logan M Barkley | Physician Assistant | 2560 24th St Ste 201, Rock Island, IL 61201-5390 | 2020-09-10 |
| 1336753342 | Navneet Kaur Bamrah | Physician Assistant | 11316 S Highland Dr, Plainfield, IL 60585-1581 | 2020-09-07 |
| 1306450424 | Annie Mannancheril | Physician Assistant | 9114 Waukegan Rd, Morton Grove, IL 60053-2135 | 2020-09-04 |
| 1508470709 | Bryan Ying Wong | Physician Assistant | 3420 S Morgan St Apt 2e, Chicago, IL 60608-6904 | 2020-09-04 |
| 1386256402 | Emma Schmidt | Physician Assistant | 20 Haverton Ct, Streamwood, IL 60107-1682 | 2020-08-19 |
| 1063024388 | Alyson Dyck | Physician Assistant | 2540 Health Services, Ssb Student Services Building, Normal, IL 61790-2540 | 2020-08-18 |
| 1649882192 | Anna Marie Phillips | Physician Assistant | 5337 Main St, Skokie, IL 60077-2029 | 2020-08-17 |
| Find all providers with the same taxonomy | ||||
| City | OLYMPIA FIELDS |
| Zip Code | 60461 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.