=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326381393
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STERLING FAMILY MEDICINE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2013
-----------------------------------------------------
Last Update Date | 03/28/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2539 E 12 MILE RD
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48092-5648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-558-5075
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2539 E 12 MILE RD
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48092-5648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-558-5075
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. OLEH J BOLUKH
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 586-558-5075
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 4301083381
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------