Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Marybeth Bolanowski, PA

Individual provider Surgical Physician Assistant · NPI 1891781639

Marybeth Bolanowski, PA is a Physician Assistant in Lombard, Illinois. Qualified in 1997, 29 years ago. Practices with Dupage Medical Group Ltd, a 1,328-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
29
Licensed in
IL
In the registry since
2005
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1801 S Highland Ave Ste 220
Lombard, IL 60148-4932
Phone: (630) 790-1872
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 085001424 (IL)
Surgical Physician Assistant Taxonomy 363AS0400X · Licence 085001424 (IL)

Record details

NPI number1891781639
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedSeptember 27, 2005
Last updated in NPPESJune 27, 2023
Certification dateJune 27, 2023
Mailing addressPo Box 713260, Chicago, IL 60677-1260

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 1997 (29 years in practice)
Group practice Dupage Medical Group Ltd — 1328 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations6 on file with Medicare

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