Healthcare Provider Details

I. General information

NPI: 1245491620
Provider Name (Legal Business Name): KARINA J BOUFFARD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 E ERIE ST FL 14
CHICAGO IL
60611-3167
US

IV. Provider business mailing address

355 E ERIE ST FL 14
CHICAGO IL
60611-3167
US

V. Phone/Fax

Practice location:
  • Phone: 312-238-7800
  • Fax: 312-238-7801
Mailing address:
  • Phone: 312-238-7800
  • Fax: 312-238-7801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number036-133242
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number036-133242
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number036-133242
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: