MEDICARE: LISA BOLINDER AT

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	096000633	IL

General Provider Information

NPI Number	:	1750047932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA BOLINDER AT

Provider Business Mailing Address
First Line	:	1600 E GOLF RD
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60016-1256
Country	:	US
Telephone Number	:	847-635-1729
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 E GOLF RD
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60016-1256
Country	:	US
Telephone Number	:	847-635-1729
Fax Number	:

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

Provider Enumeration Date	:	11/12/2021
Last Update Date	:	11/12/2021

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Directions to “ LISA BOLINDER AT” Practice Location

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