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NPI Code Detail

MEDICARE: ANDREW S BOLLIER PA

MEDICARE: ANDREW S BOLLIER PA
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
1363A00000XPhysician Assistant10000595AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1970029681OTHERINRAIL ROAD MEDCARE

General Provider Information

NPI Number : 1750373981
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW S BOLLIER PA
Provider Business Mailing Address
First Line : 5050 N CLINTON ST
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-5822
Country : US
Telephone Number : 260-484-8551
Fax Number : 260-484-9603
Provider Business Practice Location Address
First Line : 5050 N CLINTON ST
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-5822
Country : US
Telephone Number : 260-484-8551
Fax Number : 260-484-9603
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2005
Last Update Date : 10/20/2010

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