MEDICARE: JULIE A BAFIA 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		IL

General Provider Information

NPI Number	:	1639132921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE A BAFIA ATC

Provider Business Mailing Address
First Line	:	23W121 KINGS CT
Second Line	:
City	:	GLEN ELLYN
State	:	IL
Zip	:	60137-7215
Country	:	US
Telephone Number	:	773-412-9208
Fax Number	:

Provider Business Practice Location Address
First Line	:	2035 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3935
Country	:	US
Telephone Number	:	773-528-7502
Fax Number	:	773-528-7702

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

Provider Enumeration Date	:	04/08/2006
Last Update Date	:	07/08/2007

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