| John Bolden M.D. S.C. | |
|
114 W Waverly St Morris IL 60450-1422 | |
| (708) 349-0055 | |
| Not Available |
| Full Name | John Bolden M.D. S.C. |
|---|---|
| Speciality | Internal Medicine - Infectious Disease |
| Location | 114 W Waverly St, Morris, Illinois |
| Authorized Official Name and Position | John Bolden (OWNER) |
| Authorized Official Contact | 7083490055 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| John Bolden M.D. S.C. 10660 W 143rd St Ste B Orland Park IL 60462-1989 Ph: (708) 349-0055 | John Bolden M.D. S.C. 114 W Waverly St Morris IL 60450-1422 Ph: (708) 349-0055 |
| NPI Number | 1891977294 |
|---|---|
| Provider Enumeration Date | 11/28/2007 |
| Last Update Date | 02/03/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891977294 | NPI | - | NPPES |
| 036106844 | Medicaid | IL | |
| 03232029 | Other | IL | BLUE CROSS BLUE SHIELD |
| DE2561 | Other | IL | PALMETTO RR MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | 036106844 (Illinois) | Primary |
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