Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 181000276 | IL |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 181000276 | IL |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 181000276 | IL |
N | 2081P2900X | Pain Medicine | 181000276 | IL |
N | 2081S0010X | Sports Medicine | 181000276 | IL |
N | 213ES0000X | Sports Medicine | 181000276 | IL |
NPI | 1487980470 |
---|---|
Provider Name | Mary Ellen Boyte |
First Address | Des Plaines, IL 60016-3015 |
Second Address | Chicago, IL 60641-4001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2009 |
Last Update Date | 03/09/2021 |