MR. GARY FISK (NPI# 1891708491) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891708491 |
| Entity Type | Individual |
| Full Name | MR. GARY FISK |
| Credential | PA |
| Practice Address |
5405 N Knoxville Ave Peoria IL 61614-5016 |
| Practice Telephone | 3096914410 |
| Mailing Telephone | 3096914410 |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
085000405 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
5405 N KNOXVILLE AVE |
| City | PEORIA |
| State | IL |
| Zip Code | 61614-5016 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558336214 | Tinoy Kizhakekuttu | Internal Medicine | 5405 N Knoxville Ave, Heartcare Midwest, Peoria, IL 61614-5016 | 2006-02-17 |
| 1750920039 | Moriah Johnson | Nurse Practitioner | 5405 N Knoxville Ave, Peoria, IL 61614-5016 | 2020-01-03 |
| 1942859681 | Amy Underwood Fallings | Nurse Practitioner | 5405 N Knoxville Ave, Peoria, IL 61614-5016 | 2019-09-05 |
| 1912473273 | Tien T Pham | Nurse Practitioner | 5405 N Knoxville Ave, Peoria, IL 61614-5016 | 2018-10-15 |
| 1396254728 | Karen C Knaak | Nurse Practitioner | 5405 N Knoxville Ave, Peoria, IL 61614-5016 | 2017-09-28 |
| 1720455611 | Elizabeth Schwandner | Nurse Practitioner | 5405 N Knoxville Ave, Peoria, IL 61614-5016 | 2015-08-26 |
| 1558707182 | Osf Heart & Vascular Institute | Internal Medicine | 5405 N Knoxville Ave, Peoria, IL 61614-5016 | 2013-05-22 |
| 1528318128 | Rebecca Wigant | Nurse Practitioner | 5405 N Knoxville Ave, Peoria, IL 61614-5016 | 2012-09-12 |
| 1588999700 | Heather B Martin | Physician Assistant | 5405 N Knoxville Ave, Peoria, IL 61614-5016 | 2009-10-06 |
| 1285876607 | Ekanka Mukhopadhyay | Internal Medicine | 5405 N Knoxville Ave, Peoria, IL 61614-5016 | 2009-03-31 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548818511 | Christine Svoboda | Social Worker | 6919 N Knoxville Ave Ste 100 and 202, Peoria, IL 61614 | 2019-09-03 |
| 1639649007 | Kathy Karouzos Counseling, LLC | Clinic/Center | 330 W. Ivy Ln., Peoria, IL 61614 | 2018-11-28 |
| 1205312790 | Kathleen Marie Hendricks | Nurse Practitioner | 2809 W Willow Knolls Dr, Peoria, IL 61614 | 2018-07-17 |
| 1629563937 | Mary Elizabeth Cunningham | Counselor | 6219 N. Eldorado Dr., Peoria, IL 61614 | 2018-06-28 |
| 1861937955 | Angela Gilles | Social Worker | 6919 N Knoxville Ave Ste 100, Peoria, IL 61614 | 2016-12-27 |
| 1467994897 | Melissa Saxsma | Specialist | 5009 N Executive Dr, Peoria, IL 61614 | 2016-11-16 |
| 1902258874 | Rashid Plastic Surgery, LLC | Plastic Surgery | 804 W Trailcreek Drive, Peoria, IL 61614 | 2016-07-05 |
| 1215313143 | Melissa Lynn Phelan | Nurse Practitioner | 122 E Morningside Dr, Peoria, IL 61614 | 2015-08-03 |
| 1811380165 | All Ways Caring Services, Inc. | In Home Supportive Care | 6919 N Knoxville Ave, Suite 102, Peoria, IL 61614 | 2015-03-11 |
| 1568875920 | Schuler & Arkwell Orthodontic Partnership | Dentist | 2425 Cornerstone Ct. Ste. A, Peoria, IL 61614 | 2014-06-03 |
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| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669855193 | Sun Valley Surgical Physician Assistant, LLC | Physician Assistant | 9031 W Runion Dr, Peoria, AZ 85382-6472 | 2015-07-01 |
| 1487166690 | Erin M Carmean | Physician Assistant | 6000 N Allen Rd, Peoria, IL 61614-3294 | 2017-10-27 |
| 1427333087 | Colette K Hill | Physician Assistant | 1001 Main St Ste 300, Peoria, IL 61606-2036 | 2011-10-14 |
| 1184927709 | Mark D Lauffer | Physician Assistant | 6000 N Allen Rd, Peoria, IL 61614-3294 | 2010-12-21 |
| 1952476103 | Rebecca Barrick | Physician Assistant | 420 Ne Glen Oak Ave, Ste 301, Peoria, IL 61603-3105 | 2006-11-22 |
| 1770507246 | Benjamin M Holman | Physician Assistant | 6000 N Allen Road, Peoria, IL 61614-3294 | 2006-07-27 |
| 1245268820 | Michael A Bumanglag | Physician Assistant | 9165 W Thunderbird Rd, Suite 200, Peoria, AZ 85381-4847 | 2006-06-30 |
| 1013972512 | Rob Wimmer | Physician Assistant | 7309 N Knoxville Ave, Peoria, IL 61614-2085 | 2006-04-18 |
| 1851380570 | Andrew S Reese | Physician Assistant | 6000 N Allen Road, Peoria, IL 61614-3294 | 2005-10-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477169522 | Priority Assist Pllc | Physician Assistant | 48 Glenda Ln, Plano, IL 60545-9652 | 2020-09-23 |
| 1154944478 | Diana Goldak | Physician Assistant | 3855 N Parkway Dr Apt 3a, Northbrook, IL 60062-7218 | 2020-05-20 |
| 1033742580 | Colleen Courtney | Physician Assistant | 218 S Driftwood Trl, Mchenry, IL 60050-5454 | 2020-02-12 |
| 1326678962 | Nina Kodros | Physician Assistant | 301 Madison St Ste 280, Joliet, IL 60435-6672 | 2020-01-23 |
| 1689218190 | Jennifer Richman | Physician Assistant | 1890 Silver Cross Blvd Ste 410, New Lenox, IL 60451-9547 | 2019-10-29 |
| 1710547625 | Nadia Khan | Physician Assistant | 4543 N Malden St Apt 1s, Chicago, IL 60640-5687 | 2019-06-13 |
| 1962065516 | Jorge Mantilla | Physician Assistant | 5540 N Kimball Ave Apt 3e, Chicago, IL 60625-4674 | 2019-04-18 |
| 1013479955 | Leah Rae Prager | Physician Assistant | 4400 W. 95th St., Attn: Pediatric General Surgery, Oak Lawn, IL 60453 | 2019-04-01 |
| 1770041949 | Laura Ann Ryan | Physician Assistant | 840 S Wood St Ste 417, Chicago, IL 60612-4325 | 2019-03-06 |
| 1548739782 | Helen Finke | Physician Assistant | 880 W Central Rd Ste 3300, Arlington Heights, IL 60005-2366 | 2018-11-16 |
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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.