MEDICARE: SYLVIA BOLOCZKO MD

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	207Q00000X	Family Medicine Physician	ME151089	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063400893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYLVIA BOLOCZKO MD

Provider Business Mailing Address
First Line	:	16860 US HIGHWAY 441
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-6713
Country	:	US
Telephone Number	:	352-432-8443
Fax Number	:	844-388-6186

Provider Business Practice Location Address
First Line	:	16860 US HIGHWAY 441
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-6713
Country	:	US
Telephone Number	:	352-432-8443
Fax Number	:	844-388-6186

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	10/11/2021

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Directions to “ SYLVIA BOLOCZKO MD” Practice Location

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