Provider Demographics
NPI:1851368773
Name:BOLON, MAUREEN K (MD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:K
Last Name:BOLON
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Gender:F
Credentials:MD
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Mailing Address - Street 1:645 N MICHIGAN AVE STE 900
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2823
Mailing Address - Country:US
Mailing Address - Phone:312-695-4994
Mailing Address - Fax:312-926-9630
Practice Address - Street 1:676 N SAINT CLAIR ST STE 940
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2945
Practice Address - Country:US
Practice Address - Phone:312-926-8358
Practice Address - Fax:312-926-9630
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2020-01-10
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Provider Licenses
StateLicense IDTaxonomies
IL036109801207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
H96432Medicare UPIN