Healthcare Provider Details

I. General information

NPI: 1538133038
Provider Name (Legal Business Name): ANNE-MARIE MARIE BOLLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 PHALEN BLVD # MS 41104A
SAINT PAUL MN
55130
US

IV. Provider business mailing address

SSB-6 400 E 3RD ST
DULUTH MN
55805-1951
US

V. Phone/Fax

Practice location:
  • Phone: 651-254-7980
  • Fax: 651-254-7969
Mailing address:
  • Phone: 218-786-8364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number036121817
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number47855
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: