Derek Roydavis, PA-C

Physician Assistant · Park Ridge, IL

Individual Active NPI

NPI number 1265102826

Practice location

1700 Luther Ln Ste 1170
Park Ridge, IL 60068-1270
Phone
(844) 376-3876

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NPI record

NPI
1265102826
Entity type
Individual (Type 1)
Enumeration date
September 15, 2021
Last updated
March 9, 2022
Certified
March 9, 2022
Sole proprietor
Yes

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Physician Assistant Primary 363A00000X 1186126 —
Medical Physician Assistant 363AM0700X — —
Surgical Physician Assistant 363AS0400X — —

Mailing address

29373 Network Pl
Chicago, IL 60673-1293
Phone
(478) 390-5900

Other practice locations (1)

  • 41 Mesa Dr, Bethany, CT 06524-3093 · (203) 980-3234

About Derek Roydavis

Derek Roydavis, PA-C is a healthcare provider registered in the NPI registry with the primary taxonomy Physician Assistant (code 363A00000X). The practice location is 1700 Luther Ln Ste 1170, Park Ridge, IL 60068-1270. The NPI number 1265102826 was assigned on September 15, 2021 and the record was last updated on March 9, 2022.

Derek Roydavis lists a license in the registry: #1186126 for Physician Assistant. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Derek Roydavis, PA-C?

The NPI number is 1265102826.

What is the phone number of Derek Roydavis?

The phone number listed for the practice location is (844) 376-3876.

Where is Derek Roydavis located?

1700 Luther Ln Ste 1170, Park Ridge, IL 60068-1270.

What is the taxonomy code for Derek Roydavis?

The primary taxonomy code is 363A00000X – Physician Assistant; 2 more listed above.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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