MEDICARE: ALFREDO BOLASINI MD

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	2084P0800X	Psychiatry Physician	ME31450	FL

General Provider Information

NPI Number	:	1902198864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALFREDO BOLASINI MD

Provider Business Mailing Address
First Line	:	4040 N HILLS DR
Second Line	:	SUITE 32
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-2464
Country	:	US
Telephone Number	:	954-456-6336
Fax Number	:

Provider Business Practice Location Address
First Line	:	4040 N HILLS DR
Second Line	:	SUITE 32
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-2464
Country	:	US
Telephone Number	:	954-456-6336
Fax Number	:

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

Provider Enumeration Date	:	05/11/2011
Last Update Date	:	05/11/2011

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