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1366494270

NPI Code Detail

MEDICARE: DR. AMY G BOLMER D.O.

MEDICARE: DR. AMY G BOLMER D.O.

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	207RX0202X	Medical Oncology Physician	5101013135	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00122957	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1009476	OTHER	MI	MCLAREN HEALTH ADVANTAGE
3	200000001266	OTHER	MI	PHYSICIANS HEALTH PLAN
4	36-70041	OTHER	MI	PHP FAMILY CARE
5	36-00041	OTHER	MI	PHP
6	383267121	OTHER	MI	PPOM
7	7541326	OTHER	MI	AETNA
8	1153310564	OTHER	MI	BCBS/BCN
9	383267121	OTHER	MI	SPHN
10	383267121	OTHER	MI	PHCS
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366494270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY G BOLMER D.O.

Provider Business Mailing Address
First Line	:	4602 DEPT
Second Line	:
City	:	CAROL STREAM
State	:	IL
Zip	:	60122-0021
Country	:	US
Telephone Number	:	906-225-3630
Fax Number	:	906-225-4537

Provider Business Practice Location Address
First Line	:	1140 N STATE ST
Second Line	:
City	:	SAINT IGNACE
State	:	MI
Zip	:	49781-1048
Country	:	US
Telephone Number	:	906-643-0451
Fax Number	:	906-643-0461

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	08/26/2025

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Directions to “ DR. AMY G BOLMER D.O.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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