Individual
LARRY M BOEHLKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
676 N ST CLAIR, STE 2140, CHICAGO, IL 60611
(312) 664-5400
(312) 664-5854
Mailing address
25068 NETWORK PL, CHICAGO, IL 60673-0001
(847) 585-7000
(847) 240-0622
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209002685
IL
Other
Enumeration date
02/02/2006
Last updated
06/02/2010
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