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Individual

MS. TINA M BOUSMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
4400 W 95TH ST, SUITE 306, OAK LAWN, IL 60453-2654
(708) 346-5562
(708) 346-2059
Mailing address
4400 W 95TH ST, SUITE 306, OAK LAWN, IL 60453-2654
(708) 346-5562
(708) 346-2059

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085-002077
IL

Other

Enumeration date
09/21/2005
Last updated
05/17/2010
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