Healthcare Provider Details

I. General information

NPI: 1821033671
Provider Name (Legal Business Name): AHDY ANIS BOLIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 08/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MOBILE INFIRMARY CIR POB SUITE 308
MOBILE AL
36607-3513
US

IV. Provider business mailing address

5 MOBILE INFIRMARY CIR POB SUITE 308
MOBILE AL
36607-3513
US

V. Phone/Fax

Practice location:
  • Phone: 251-435-7223
  • Fax: 251-435-7282
Mailing address:
  • Phone: 251-435-7223
  • Fax: 251-435-7282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.28465
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.28465
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: