Healthcare Provider Details

I. General information

NPI: 1386781755
Provider Name (Legal Business Name): MR. ANDREAS JOSEF BOHNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N CHILDRENS PLZ # 46
CHICAGO IL
60614-3363
US

IV. Provider business mailing address

5336 N NEW ENGLAND AVE
CHICAGO IL
60656-2014
US

V. Phone/Fax

Practice location:
  • Phone: 773-327-1022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: