MEDICARE: KRISTIAN BULLINER

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
1	104100000X	Social Worker	150.109839	IL

General Provider Information

NPI Number	:	1356052435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIAN BULLINER

Provider Business Mailing Address
First Line	:	14300 S RAVINIA AVE STE 100
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-2578
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14300 S RAVINIA AVE STE 100
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-2578
Country	:	US
Telephone Number	:	855-205-4764
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2022
Last Update Date	:	12/08/2022

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Directions to “ KRISTIAN BULLINER ” Practice Location

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