Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | ME139818 | FL |
N | 208G00000X | Cardiothoracic Vascular Surgeon | R3392 | KY |
NPI | 1063708600 |
---|---|
Provider Name | Michael Bolanos |
First Address | Atlantis, FL 33462-6641 |
Second Address | Atlantis, FL 33462-6641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2011 |
Last Update Date | 27/09/2021 |