MEDICARE: MICHAEL J NABOLOTNY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	36068022	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	01616662	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1225021470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL J NABOLOTNY MD

Provider Business Mailing Address
First Line	:	7447 W TALCOTT AVE
Second Line	:	STE 216
City	:	CHICAGO
State	:	IL
Zip	:	60631-3713
Country	:	US
Telephone Number	:	773-631-0566
Fax Number	:	773-631-4436

Provider Business Practice Location Address
First Line	:	7447 W TALCOTT AVE STE 216
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-3713
Country	:	US
Telephone Number	:	773-775-1900
Fax Number	:	773-775-8034

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	01/11/2025

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