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NPI Code Detail

MEDICARE: JAMES EDWIN BOLANDER II M.D.

MEDICARE: JAMES EDWIN BOLANDER II 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
1207RN0300XNephrology Physician01039451IN
2207RN0300XNephrology Physician01039451AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000083029OTHERINANTHEM NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639176464
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES EDWIN BOLANDER II M.D.
Provider Business Mailing Address
First Line : 120 W 22ND ST STE 200
Second Line :
City : OAK BROOK
State : IL
Zip : 60523-1563
Country : US
Telephone Number : 630-573-5000
Fax Number : 317-882-2873
Provider Business Practice Location Address
First Line : 5510 S EAST ST STE H
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46227-1939
Country : US
Telephone Number : 317-924-8425
Fax Number : 317-924-8424
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 11/29/2022

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