MEDICARE: MRS. NADINE LOLLINO

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	174400000X	Specialist	227001356	IL

General Provider Information

NPI Number	:	1497153027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NADINE LOLLINO

Provider Business Mailing Address
First Line	:	1658 N MILWAUKEE AVE # 361
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-6905
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1658 N MILWAUKEE AVE # 361
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-6905
Country	:	US
Telephone Number	:	312-208-8409
Fax Number	:

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

Provider Enumeration Date	:	12/13/2014
Last Update Date	:	12/13/2014

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