Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 102120 | MO |
NPI | 1043325970 |
---|---|
Provider Name | Dr. Michael Joseph Bolger |
First Address | Saint Louis, MO 63131-2329 |
Second Address | Saint Louis, MO 63131-2329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 29/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E89513 | (02) |