MEDICARE: CHRISTINA SUAREZ

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1740721828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA SUAREZ

Provider Business Mailing Address
First Line	:	5730 N OCTAVIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-3064
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5730 N OCTAVIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-3064
Country	:	US
Telephone Number	:	773-414-4874
Fax Number	:

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

Provider Enumeration Date	:	03/09/2017
Last Update Date	:	03/09/2017

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Directions to “ CHRISTINA SUAREZ ” Practice Location

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