Healthcare Provider Details

I. General information

NPI: 1134688153
Provider Name (Legal Business Name): LINDSAY HALLETT BOLES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 02/15/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8915 W CONNELL AVE
MILWAUKEE WI
53226-3067
US

IV. Provider business mailing address

CHILDREN'S CORPORATE CENTER, SUITE C550 999 N. 92ND ST. P.O. BOX 1997
MILWAUKEE WI
53201-1997
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.159848
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number81528-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: