Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 2016017329 | MO |
N | 207VE0102X | Reproductive Endocrinologist | MT221504 | PA |
NPI | 1477901460 |
---|---|
Provider Name | Dr. Kassie Jean Bollig |
First Address | Philadelphia, PA 19104-5502 |
Second Address | Philadelphia, PA 19104-5502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2016 |
Last Update Date | 03/07/2020 |