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NPI Code Detail

MEDICARE: MONICA M PARKS ATC

MEDICARE: MONICA M PARKS 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
12255A2300XAthletic Trainer36001790AIN

General Provider Information

NPI Number : 1669749727
Entity Type Code : Individual
Provider Name (Legal Business Name) : MONICA M PARKS ATC
Provider Business Mailing Address
First Line : 790 REMINGTON BLVD
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60440-4909
Country : US
Telephone Number : 630-296-2223
Fax Number : 630-759-3251
Provider Business Practice Location Address
First Line : 2333 POST DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-1979
Country : US
Telephone Number : 317-890-7700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2011
Last Update Date : 11/17/2011

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