MEDICARE: KATHERINE BOLT 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	207V00000X	Obstetrics & Gynecology Physician	BP1-00300992	TX

General Provider Information

NPI Number	:	1073750477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE BOLT M.D.

Provider Business Mailing Address
First Line	:	PO BOX 66308
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77266-6308
Country	:	US
Telephone Number	:	832-548-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	6550 MAPLERIDGE ST STE 106
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-4629
Country	:	US
Telephone Number	:	832-548-5000
Fax Number	:

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

Provider Enumeration Date	:	01/07/2009
Last Update Date	:	11/19/2018

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