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General NPI Number Information
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NPI Number | 1376668475
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICAL CENTER OF BOLINGBROOK SC
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 05/26/2010
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Provider Practice Location Address
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Address Line | 516 E BOUGHTON RD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-2181
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Country | US
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Telephone | 630-739-2878
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Fax |
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Provider Business Mailing Address
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Address Line | 516 E BOUGHTON RD
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City | BOLINGBROOK
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State | IL
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Zip | 60440-2181
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANTONIO CARLINO
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Credential | D.O.
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Telephone | 630-739-2878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 036-098970
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License Number State | IL
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