Healthcare Provider Details

I. General information

NPI: 1366494270
Provider Name (Legal Business Name): AMY G BOLMER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 N STATE ST
SAINT IGNACE MI
49781-1048
US

IV. Provider business mailing address

4602 DEPT
CAROL STREAM IL
60122-0021
US

V. Phone/Fax

Practice location:
  • Phone: 906-643-0451
  • Fax: 906-643-0461
Mailing address:
  • Phone: 906-225-3630
  • Fax: 906-225-4537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number5101013135
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: