MEDICARE: MR. GRANT SLOVIN ATC

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1295237303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GRANT SLOVIN ATC

Provider Business Mailing Address
First Line	:	9457 LAWLER AVE
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60077-1272
Country	:	US
Telephone Number	:	224-436-7707
Fax Number	:

Provider Business Practice Location Address
First Line	:	BOWLING GREEN STATE UNIVERSITY
Second Line	:
City	:	BOWLING GREEN
State	:	OH
Zip	:	43403-4607
Country	:	US
Telephone Number	:	419-372-2531
Fax Number	:

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

Provider Enumeration Date	:	03/05/2018
Last Update Date	:	07/02/2020

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