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NPI Code Detail

MEDICARE: JOSEPH QUALTER

MEDICARE: JOSEPH QUALTER
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 Trainer
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1205582186
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPH QUALTER
Provider Business Mailing Address
First Line : 9243 S HAMLIN AVE
Second Line :
City : EVERGREEN PARK
State : IL
Zip : 60805-1419
Country : US
Telephone Number : 708-704-7832
Fax Number :
Provider Business Practice Location Address
First Line : 315 TURNPIKE ST
Second Line :
City : NORTH ANDOVER
State : MA
Zip : 01845-5800
Country : US
Telephone Number : 708-704-7832
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2022
Last Update Date : 03/01/2022

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Directions to “ JOSEPH QUALTER ” Practice Location

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