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General NPI Number Information
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NPI Number | 1366494270
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Entity Type | Individual
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Provider Name | AMY G BOLMER D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 1140 N STATE ST
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City | SAINT IGNACE
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State | MI
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Zip | 49781-1048
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Country | US
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Telephone | 906-643-0451
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Fax | 906-643-0461
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Provider Business Mailing Address
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Address Line | 4602 DEPT
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City | CAROL STREAM
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State | IL
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Zip | 60122-0021
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Country | US
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Telephone | 906-225-3630
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Fax | 906-225-4537
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 5101013135
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License Number State | MI
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