MEDICARE: DR. MEELIE BORDOLOI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	2019024446	MO
2	2084P0800X	Psychiatry Physician	2019024446	MO

General Provider Information

NPI Number	:	1033593991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEELIE BORDOLOI M.D.

Provider Business Mailing Address
First Line	:	1800 COMMUNITY
Second Line	:
City	:	CLINTON
State	:	MO
Zip	:	64735-8804
Country	:	US
Telephone Number	:	660-885-8131
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 W NIFONG BLVD STE 140
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-5615
Country	:	US
Telephone Number	:	573-884-1130
Fax Number	:	573-884-5936

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2015
Last Update Date	:	08/16/2022

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