Provider Demographics
NPI:1588456818
Name:BOHLIN, LUKE
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:BOHLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9N874 BECKMAN TRL
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60124-8445
Mailing Address - Country:US
Mailing Address - Phone:224-238-9935
Mailing Address - Fax:
Practice Address - Street 1:9N874 BECKMAN TRL
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60124-8445
Practice Address - Country:US
Practice Address - Phone:224-238-9935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.011214363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant