MEDICARE: BOLOR TSETSEG CASTILLO

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	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1760200083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOLOR TSETSEG CASTILLO

Provider Business Mailing Address
First Line	:	3173 CORAL LN
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-6802
Country	:	US
Telephone Number	:	312-888-5424
Fax Number	:

Provider Business Practice Location Address
First Line	:	3173 CORAL LN
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-6802
Country	:	US
Telephone Number	:	312-888-5424
Fax Number	:

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

Provider Enumeration Date	:	09/26/2024
Last Update Date	:	09/26/2024

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Directions to “ BOLOR TSETSEG CASTILLO ” Practice Location

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