Doctor Name: | MICHELLE BOLANO |
NPI Number: | 1750580049 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | D.P.T. |
License Number: | |
Business Practice Address: | 1800 Hollister Dr Suite 205 Libertyville, IL - 600485263 |
Business Phone Number: | 8479187947 |
Business Fax Number: | |
Mailing Address: | 530 Sheridan Rd, Apt 2b EVANSTON |
State: | IL |
Postal Code: | 602023119 |
Phone Number: | 8472047919 |
Fax Number: | |
NPI Enumeration Date: | 07/16/2007 |
NPI Last Update Date: | 07/16/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |