Healthcare Provider Details

I. General information

NPI: 1215336177
Provider Name (Legal Business Name): BOLAD ARTHRITIS & RHEUMATOLOGY CLINIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2014
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1646 33RD ST STE 101
ORLANDO FL
32839-8866
US

IV. Provider business mailing address

1646 33RD ST STE 101
ORLANDO FL
32839-8866
US

V. Phone/Fax

Practice location:
  • Phone: 407-409-8118
  • Fax: 407-264-6562
Mailing address:
  • Phone: 407-409-8118
  • Fax: 407-264-6562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME120763
License Number StateFL

VIII. Authorized Official

Name: DR. WALEED A BOLAD
Title or Position: RHEUMATOLOGIST
Credential: MD
Phone: 434-466-2996