MEDICARE: MICHELA PAGANO ATC/L

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	096.002194	IL

General Provider Information

NPI Number	:	1891760310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELA PAGANO ATC/L

Provider Business Mailing Address
First Line	:	7959 W BRYN MAWR AVE
Second Line	:
City	:	NORWOOD PARK
State	:	IL
Zip	:	60631-2906
Country	:	US
Telephone Number	:	708-867-0053
Fax Number	:

Provider Business Practice Location Address
First Line	:	7959 W BRYN MAWR AVE
Second Line	:
City	:	NORWOOD PARK
State	:	IL
Zip	:	60631-2906
Country	:	US
Telephone Number	:	708-867-0053
Fax Number	:

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

Provider Enumeration Date	:	02/19/2006
Last Update Date	:	04/05/2013

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