MEDICARE: LINDSAY BOLL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	5601007894	MI

General Provider Information

NPI Number	:	1912452863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSAY BOLL

Provider Business Mailing Address
First Line	:	155 ROCHDALE DR S STE A
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-2276
Country	:	US
Telephone Number	:	248-608-0360
Fax Number	:	246-608-0362

Provider Business Practice Location Address
First Line	:	155 ROCHDALE DR S STE A
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-2276
Country	:	US
Telephone Number	:	248-608-0360
Fax Number	:	248-608-0362

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2016
Last Update Date	:	04/15/2024

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Directions to “ LINDSAY BOLL ” Practice Location

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