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General NPI Number Information
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NPI Number | 1972098499
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Entity Type | Individual
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Provider Name | STEPHEN BOLLINGER MD
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Gender | Male
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Dates
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Enumeration Date | 06/27/2018
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 800 ROSE ST
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City | LEXINGTON
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State | KY
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Zip | 40536-5431
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Country | US
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Telephone | 859-323-2636
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Fax |
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Provider Business Mailing Address
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Address Line | 2614 FORUM BLVD STE 100
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City | COLUMBIA
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State | MO
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Zip | 65203-5431
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Country | US
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Telephone | 573-445-5366
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Fax | 573-313-3571
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | R3915
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 2021039572
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License Number State | MO
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