MEDICARE: KEIONYA BOLAR

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	224P00000X	Prosthetist	BYMOJYL6U7	IN

General Provider Information

NPI Number	:	1508639642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEIONYA BOLAR

Provider Business Mailing Address
First Line	:	3250A W 86TH ST # 1026
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-3605
Country	:	US
Telephone Number	:	833-576-9633
Fax Number	:

Provider Business Practice Location Address
First Line	:	3250A W 86TH ST # 1026
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-3605
Country	:	US
Telephone Number	:	833-576-9633
Fax Number	:

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

Provider Enumeration Date	:	10/31/2023
Last Update Date	:	03/01/2024

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Directions to “ KEIONYA BOLAR ” Practice Location

Language	Start Address	Practice Location

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