Individual
JAIME O BOLANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2209 W CERMAK RD, CHICAGO, IL 60608-3916
(773) 847-1199
(773) 847-6592
Mailing address
2209 W CERMAK RD, CHICAGO, IL 60608-3916
(773) 847-1199
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036061720
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036061720
—
IL
01
—
31620158
BLUE SHIELD
IL
Enumeration date
09/21/2006
Last updated
07/23/2015
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