MEDICARE: JAIME O BOLANO M.D.

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	036061720	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	31620158	OTHER	IL	BLUE SHIELD

General Provider Information

NPI Number	:	1497854038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIME O BOLANO M.D.

Provider Business Mailing Address
First Line	:	2209 W CERMAK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-3916
Country	:	US
Telephone Number	:	773-847-1199
Fax Number	:

Provider Business Practice Location Address
First Line	:	2209 W CERMAK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-3916
Country	:	US
Telephone Number	:	773-847-1199
Fax Number	:	773-847-6592

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	07/23/2015

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Directions to “ JAIME O BOLANO M.D.” Practice Location

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