Healthcare Provider Details
I. General information
NPI: 1568859775
Provider Name (Legal Business Name): FRANCES BOLY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 04/26/2015
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:
III. Provider practice location address
4440 W 95TH ST STE 301
OAK LAWN IL
60453-2600
US
IV. Provider business mailing address
29373 NETWORK PL
CHICAGO IL
60673-2600
US
V. Phone/Fax
- Phone: 708-684-1840
- Fax:
- Phone: 847-390-5900
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 390200000X |
| Taxonomy | Student in an Organized Health Care Education/Training Program |
| License Number | |
| License Number State | NULL |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207RI0200X |
| Taxonomy | Infectious Disease Physician |
| License Number | 2018011904 |
| License Number State | MO |
| # 3 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207RI0200X |
| Taxonomy | Infectious Disease Physician |
| License Number | 036-152432 |
| License Number State | IL |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: