Healthcare Provider Details

I. General information

NPI: 1972098499
Provider Name (Legal Business Name): STEPHEN BOLLINGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST
LEXINGTON KY
40536-5431
US

IV. Provider business mailing address

2614 FORUM BLVD STE 100
COLUMBIA MO
65203-5431
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-2636
  • Fax:
Mailing address:
  • Phone: 573-445-5366
  • Fax: 573-313-3571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberR3915
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2021039572
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: