Healthcare Provider Details

I. General information

NPI: 1386671691
Provider Name (Legal Business Name): NORMAN ALEXANDER BOLZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19229 MACK AVE SUITE 34
GROSSE POINTE MI
48236
US

IV. Provider business mailing address

19229 MACK AVE SUITE 34
GROSSE POINTE MI
48236
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-0209
  • Fax: 313-343-0427
Mailing address:
  • Phone: 313-343-0209
  • Fax: 313-343-0427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberNB039815
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: