Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 036-133242 | IL |
Y | 2081P2900X | Pain Medicine | 036-133242 | IL |
NPI | 1245491620 |
---|---|
Provider Name | Karina J Bouffard |
First Address | Chicago, IL 60611-4501 |
Second Address | Chicago, IL 60611-4501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2008 |
Last Update Date | 01/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036133242-1 | (05) | IL |