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NPI Code Detail

MEDICARE: LESLEY SHULMAN ATC

MEDICARE: LESLEY SHULMAN ATC
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 Trainer2601001783MI

General Provider Information

NPI Number : 1649722620
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLEY SHULMAN ATC
Provider Business Mailing Address
First Line : 8421 LOTUS AVE
Second Line :
City : SKOKIE
State : IL
Zip : 60077-2019
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 110 S MADISON ST
Second Line :
City : ADRIAN
State : MI
Zip : 49221-2518
Country : US
Telephone Number : 517-264-3168
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2016
Last Update Date : 10/26/2016

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Directions to “ LESLEY SHULMAN ATC” Practice Location

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